Association between Baseline Patient-reported Outcomes and Complications of Hematopoietic Stem Cell Transplantation (HCT)

Abstract Background Hematopoietic cell transplantation (HCT) is a potentially curative therapy for hematologic malignancies, but often results in significant toxicities and impaired quality of life (QOL). Although the value of patient-reported outcomes (PROs) is increasingly recognized in HCT, data are limited regarding the relationship between PROs and HCT complications. Study Design We conducted a secondary data analysis of 250 patients who were hospitalized for autologous or allogeneic HCT at Massachusetts General Hospital from 2011 through 2016. We assessed QOL (Functional Assessment of Cancer Therapy-General), mood (Hospital Anxiety and Depression Scale), and fatigue (FACT-Fatigue) at baseline. We abstracted from the Electronic Health Record: 1) hospitalization during the first 100 days post-HCT, 2) days alive and out of the hospital in the first 100 days post-HCT, and 3) cumulative incidence of acute graft-versus-host-disease (GVHD) among allogeneic HCT recipients. We assessed the association of baseline PROs with HCT complications using multivariable models adjusting for patient and transplant characteristics. Results Overall, 44.4% (111/250) of patients underwent an autologous HCT, 25.2% (63/250) received a myeloablative allogeneic HCT, and 30.4% (76/250) underwent a reduced intensity allogeneic HCT. In multivariable logistic regression, higher anxiety (OR=1.14, p=0.004) was associated with higher likelihood of re-hospitalization within 100 days post-HCT. In multivariable Poisson regression, lower fatigue (β=0.003, p=0.015) was associated with increased days alive and out of the hospital in the first 100 days post-HCT. In multivariable logistic regression, lower baseline QOL (OR=0.97, p=0.034), higher fatigue (OR=0.95, p=0.004), and higher depression (OR=1.15, p=0.020) were associated with increased likelihood of acute GVHD. Conclusions Baseline PROs are associated with health care utilization post-HCT and risk of acute GVHD in allogeneic HCT recipients. These findings underscore the potential utility of pre-transplant PROs as important prognostic factors for HCT.