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Study Examines Quality Of Life After Stem Cell Transplantation

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Published: Jul 8, 2009 4:53 pm

A study published in the July issue of the journal Blood examines quality of life in individuals who have undergone allogeneic hematopoietic cell transplantation (HCT), a procedure often used to treat multiple myeloma patients.

Allogeneic HCT involves the transplantation of stem cells donated from one person to another person. Stem cells, found in the bone marrow, develop into red blood cells, white blood cells, and blood platelets. When a person with myeloma or another type of blood cancer goes through chemotherapy, not only do cancer cells get destroyed, but so do normal blood-cell producing stem cells. HCT restores a population of normal stem cells in the bone marrow following high doses of chemotherapy. It is a procedure that helps control and potentially cures blood cancers like myeloma.

The journal article reviewed current literature available on quality of life following allogeneic HCT in adult patients. Quality of life, according to the article, is “a dynamic, multifaceted concept related to physical, cognitive, emotional, and social functioning and well-being.”

The authors of the article first acknowledge that certain factors describing the impact of HCT on quality of life, such as study design, patient population, and assessment instruments, may vary greatly from study to study. They state that a cohesive overview is needed to integrate all of the studies and fully describe the effects of all findings.

The article breaks quality of life into several subcategories – physical functioning, emotional functioning, social functioning, and role functioning – and examines how studies have found HCT to affect each one.

According to the article, studies have determined that patients who survive transplantation experience a rapid decline in physical functioning following the procedure. The worst effects are often seen between 30 and 100 days, but physical functioning begins to improve thereafter. Two studies found that physical functioning levels out after a year, and another one reported patients experiencing consistent improvement over four years.

According to one study, allogeneic HCT patients can expect long-term physical functioning similar to or worse than what they experienced before the transplantation. In particular, the study found that 25% of patients report major physical limitations at the time of transplantation, 44% at 90 days after treatment, 12% at one year after treatment, 22% at three years after treatment, and 18% at five years after treatment.

Emotional functioning is also most compromised early in the treatment process. The study reports that significant improvements in this area can be seen as early as hospital discharge to 100 days after transplantation. Some studies on emotional functioning following HCT suggest that patients remain fairly stable after the initial improvement, while other studies propose that additional improvement may be seen two to four years after transplantation occurs.

Although data on short-term social functioning conflict with one another, the article examines the more cohesive results on long-term social functioning. Studies found that after one year, survivors reported similar or better levels of social functioning compared to before the transplantation and showed continued improvement in years one through four.

The article states that role functioning – the ability of a person to perform at work, school, or homemaking – shows an immediate decline after allogeneic HCT but begins to improve as time passes. Though studies have differing results on whether role functioning remains the same or increases following transplantation, data suggest that by one year, 59 to 69 percent of survivors have returned to their designated tasks, and by five years post-HCT, over 84 percent of survivors have resumed their roles. According to the article authors, “The majority of survivors of allogeneic transplantation resume their roles at home and in the community after transplantation.”

The article then looks at overall quality of life, determining that good overall quality of life is often reported by patients, especially as time from transplantation increases. The study’s authors note that quality of life often drops immediately after allogeneic HCT, but then seems to stabilize or improve after 100 days, and may continue to increase. One study found that just four years after transplantation, 80 percent of survivors rated their overall quality of life as good to excellent.

Following this examination, the study makes certain comparisons between allogeneic HCT and other forms of cancer treatment, such as standard-dose chemotherapy and autologous HCT – in which stem cells are collected from the patient before chemotherapy, rather than from a donor.

Though some studies reported that patients took a longer time to recover from allogeneic HCT than autologous HCT, one of the largest studies to date suggests that there is no difference in quality of life by type of transplantation. The article sums up the results of various studies by stating that patients undergoing allogeneic transplantation report quality of life that is similar to or worse than patients undergoing autologous transplantation.

Varying results can also be seen in studies that compare allogeneic HCT with standard-dose chemotherapy. Some data suggest that patients have worse quality of life after HCT than after standard-dose chemotherapy, while other data suggests that it is relatively the same in both patient groups. The article authors acknowledge the need for further research, with special attention paid to rates of relapse.

The journal article then explains several predictors of quality of life: graft-versus-host disease, Reduced-intensity conditioning regimens, and personal characteristics.

Many studies have found that graft-versus-host disease, a condition that occurs when the body’s immune system begins to attack transplanted stem cells, to be heavily associated with a poorer quality of life in areas such as physical functioning, role functioning, social functioning, mental health, and general health.

Reduced-intensity conditioning regimens attempt to stabilize transplantation and lower the risk of complications. Though there have not been many studies about the impact of Reduced-intensity conditioning on post-transplantation quality of life, the available data suggests that the overall quality of life is “good” following reduced-intensity conditioning.

The article then acknowledges a range of personal characteristics that have been associated with poorer quality of life, such as greater degree of symptoms, lower educational level, older age, being female, sexual impotence, advanced disease at the time of transplantation, greater interpersonal conflict, and reduced level of social support.

Not all studies have focused on negative effects of HCT on patients’ quality of life. Several have looked at the patient-reported benefits of transplantation. Some of these benefits include an enhanced appreciation for life, different priorities, love and appreciation for family and friends, and greater religious or spiritual beliefs.

The article concludes with a look at how to improve one’s quality of life using behavioral interventions. The authors state that the small amount of data currently available suggest that behavioral interventions, such as supervised exercise, show promise to maintain or improve quality of life after allogeneic HCT, but that more studies in this area are needed.

For more information on how transplantation affects quality of life, please see the study at the Blood Web site.

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