Psychological Distress as a Negative Survival Factor for Patients with Hematologic Malignancies Who Underwent Allogeneic Hematopoietic Stem Cell Transplantation

Study Objective. To evaluate the influence of distress on overall survival of patients with hematologic malignancies who underwent allogeneic stem cell transplantation (allo-SCT) and to analyze the possible risk factors for death. Design. Retrospective cohort study. Setting. Large tertiary care teaching hospital. Patients. Seventy-seven patients (aged ≥ 15 yrs) with hematologic malignancies who underwent allo-SCT between January 2000 and August 2007; 20 patients with distress history were matched in a 1:3 ratio with 57 patients without distress history. Measurements and Main Results. The primary outcome was overall survival, defined as the time from allo-SCT to disease-related death or last date of follow-up. Secondary outcomes were time to hematologic recovery (absolute neutrophil count ≥ 500 cells/mm3) from day of allo-SCT, length of hospital stay, and opioid usage. Sociodemographic information and clinical characteristics were analyzed for possible risk factors. Patient history of psychological distress resulted in a significantly higher mortality rate in the first year after allo-SCT (hazard ratio [HR] 3.05, 95% confidence interval [CI] 1.48–6.28, p=0.001) and led to a shorter overall survival rate (HR 1.63, 95% CI 0.86–3.10, p=0.133). However, psychological distress had no effect on hospital length of stay, hematologic recovery time, opioid usage status, or dose of opioid analgesics used. Factors associated with death after allo-SCT in the univariate analysis (p<0.05) were high-relapse risk disease, umbilical cord blood SCT, total-body irradiation-containing conditioning regimen, and higher educational background. In the multivariate analysis, high relapse risk (HR 3.85, 95% CI 1.81–8.20, p<0.001) and total-body irradiation-containing conditioning regimen (HR 3.50, 95% CI 1.29–9.51, p=0.01) were identified as risk factors for death. Conclusion. A history of psychological distress before allo-SCT, after adjusting for other patient- and disease-related prognostic factors, had a significant influence on early death in the first year after transplantation.