engleski

Quality of Life after Hematopoietic Stem Cell Transplantation in Patients with Chronic Graft- Versus-Host Disease

Introduction: Chronic graft-versus-host disease (cGVHD) is the leading cause of late morbidity and mortality after hematopoietic stem cell transplantation (HSCT) and shows a negative relationship with patient-reported quality of life (QOL). NIH scoring system for cGVHD was developed in 2005., in order to advance clinical trials for cGVHD prevention and treatment. Material (or patients) and methods: The aim of this study was to investigate the ability of two standard QOL questionnaires (SF- 36 and QLQ C30) to evaluate QOL in cGVHD patients graded according to NIH global severity scoring system. QOL was assessed in a cross-sectional way in patients who underwent HSCT in University Hospital Centre Zagreb and were alive and in complete remission for more than 1 year after HSCT. Results: The study included 58 patients (30 female, 28 male) with a median age of 43 years (range 18-71). Patients completed QOL forms at a median of 659 days (range 361-7853) after HSCT. According to NIH criteria, 21 patients did not meet criteria for cGVHD diagnosis. cGVHD was diagnosed in 37 patients ; mild in 1, moderate in 16 and severe in 20 patients, at a median of 298 days after HSCT (range 103 3886). The median of cGVHD organs involved was 2 (range 1-6) and patients received a median of 2 (range 1-4) previous lines of immunosupressive treatment. When we compared patients with and without cGVHD, those having cGVHD had signifcantly lower scores of global health status as well as significantly lower QOL in terms of all SF-36 subscales and most QLQ C30 functional subscales (Po0.05 in all subgroups). In QLQ C30 symptom scales, cGVHD patients reported significantly more pain, dyspnea and sleeping disorders (P = 0.01, P = 0.04 and P = 0.04, respectively). Furthermore, patients with severe cGVHD had lower QOL scores than patients with moderate cGVHD (Figure 1.). This difference was most evident in physical functioning and role limitations due to physical health in SF-36 (P = 0.01 and P =0.04) as well as in global status and social functioning scores in QLQ C30 (P = 0.001 and P = 0.001, respectively). Conclusion: In accordance with few previous studies that have adressed this problem, NIH severity scoring system for cGVHD is correlated with patient-reported QOL, particularly in the physical domains as detected by SF-36. In addition, QLQ C30 questionnaire adds more information on social functioning of cGVHD patients and should be used as a valuable instrument of evaluation in the social domains of QOL. In future studies we aim to continue longitudinal QOL assessement by the same means in order to improve care in cGVHD patients.

chronic graft versus host disease ; quality of life

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