Quality of Life and Comorbidities of Adult Survivors of Allogeneic Hematopoietic Cell Transplant Versus Their Siblings
Notice bibliographique
Résumé
Background: Survivors of allogeneic hematopoietic cell transplant (allo-HCT) are at risk of developing chronic health conditions. Prior studies have shown that survivors of allo-HCT in childhood/young adulthood who mainly received high dose total body irradiation (TBI)-based conditioning experience excess health conditions and more distress vs. their siblings. In recent years, allo-HCT is offered to adults of increasing age and there has been increasing use of chemotherapy +/- low dose TBI conditioning rather than high dose TBI. We set out to describe and compare the QoL and comorbidities of adults who underwent allo-HCT with chemotherapy +/- low dose TBI conditioning vs. their siblings. Methods: Allo-HCT recipients attending 1 of 2 survivorship clinics at ≥2 years post-HCT without active cGVHD or relapse, were enrolled. Beginning in 2023, participants were asked to forward an electronic version of the study survey to their biological sibling(s). The survey includes the PROMIS-Global Health instrument: raw scores are converted to a mental (MH) and physical health (PH) subscale T-score (population mean 50/SD 10). Comorbidities were scored with a published post allo-HCT morbidity index. Associations between MH and PH-related QoL, comorbidities, and patient/transplant-related variables were investigated with linear regression. Patient and sibling comparisons were made with paired sample and chi-square tests. A significance level of <0.05 was statistically significant & a difference in QoL T-score of 5 was clinically significant. Results: Of 330 patients approached during their clinic visit, 320 consented to participate (97%). To date, 105 siblings of 57 recipients have been sent surveys and 47 siblings (45%) of 32 recipients (56%) have completed the survey. Among all recipients, median age at HCT is 47 (IQR 35-57) with 21% ≥60 years old, 48% are female, 78% are Caucasian, 69% are college educated or more & 51% are working full/part-time. Median time post-HCT is 9 years (IQR 6-14). The mean PH T-score is 48.5 (SD 8.6). In the multivariable model, total number of comorbidities (p<0.01) and a work status of disability (p<0.01) are associated with inferior PH QoL. The mean MH T-score was 49.1 (SD 8.4). In the multivariable model, total number of comorbidities (p<0.01) and a work status of disability (p<0.01) are associated with inferior MH QoL. HCT characteristics, including history of moderate-severe cGVHD, and demographic characteristics are not associated with either QoL subscale. Among all recipients, the median number of comorbidities is 3 (IQR 1.5-4). The most common comorbidities include hyperlipidemia (39%), hypertension (25%) & hypothyroidism (24%). At least one severe comorbidity (vascular disease, chronic heart/lung/liver/kidney disease or subsequent malignancy) is present in 23% of patients. In multivariable analysis, a greater number of years post-HCT is associated with a greater number of comorbidities (p=0.03) and full/part-time work status is associated with fewer comorbidities (p=0.01). In the sibling-recipient comparison, median age of siblings and recipients is 55 (IQR 37-66) & 54 (IQR 40-64), respectively. The MH QoL of recipients is statistically, but not clinically, better than their siblings: T-score 52.9 (SD 7.1) versus 49.9 (SD 6.9), respectively, p=0.04. The PH QoL of recipients was not significantly different than their siblings: T-score 52.6 (SD 5.6) versus 50.7 (SD 8.2), respectively, p=0.23. Recipients are suffering from significantly more comorbidities vs. their siblings: median 2.5 (IQR 1.8-4) versus 1 (IQR 0-3), respectively, p=0.03. The prevalence of ≥1 severe comorbidity is greater in recipients vs. siblings, but not statistically significant (13% vs. 2%, p=0.06). Conclusion: Adult recipients of allo-HCT, living without cGVHD or relapse and conditioned without high dose TBI, in aggregate experience similar QoL but suffer excess chronic health conditions as compared to their siblings. One in 4 recipients are suffering from ≥1 severe chronic health condition(s). Time post-HCT is associated with comorbidities, suggesting that recipients continue to accumulate health conditions in the years post-HCT. Number of comorbidities, rather than transplant and demographic factors (including prior cGVHD), is associated with impaired MH and PH QoL. Preventative care after allo-HCT is critical, even in those receiving HCT in adulthood without high dose TBI.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».