Impact of pre-transplant depression on outcomes of allogeneic and autologous hematopoietic stem cell transplantation.
Impact of pre-transplant depression on outcomes of allogeneic and autologous hematopoietic stem cell transplantation.
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作者：
El-Jawahri A;Chen YB;Brazauskas R;He N;Lee SJ;Knight JM;Majhail N;Buchbinder D;Schears RM;Wirk BM;Wood WA;Ahmed I;Aljurf M;Szer J;Beattie SM;Battiwalla M;Dandoy C;Diaz MA;D'Souza A;Freytes CO;Gajewski J;Gergis U;Hashmi SK;Jakubowski A;Kamble RT;Kindwall-Keller T;Lazarus HM;Malone AK;Marks DI;Meehan K;Savani BN;Olsson RF;Rizzieri D;Steinberg A;Speckhart D;Szwajcer D;Schoemans H;Seo S;Ustun C;Atsuta Y;Dalal J;Sales-Bonfim C;Khera N;Hahn T;Saber W
评估自体和同种异体HCT前抑郁对移植后临床结局的影响。我们分析了来自国际血液和骨髓移植研究中心的数据，以比较自体（n=3786）或同种异体（n=7433）HCT治疗后的结局，这些患者患有血液恶性肿瘤，现有诊断为HCT前抑郁症，需要治疗，与没有HCT前抑郁症的患者相比。使用考克斯回归模型，我们比较了有或无抑郁症患者的OS。我们使用Poisson模型比较HCT后前100天的存活天数和出院天数。我们还比较了异基因HCT中II-IV级急性和慢性GVHD的发生率。纳入了2008-2012年接受同种异体HCT的1116例（15%）移植前抑郁患者和6317例（85%）无抑郁患者。移植前抑郁与较低的OS（HR=1.13，95%CI 1.04 -1.23，P=0.004）和较高的II-IV级急性GVHD发生率（HR=1.25，95%CI 1.14-1.37，P<0.0001）相关，但慢性GVHD的发生率相似。移植前抑郁与存活天数和出院天数减少相关（平均值比（MR）=0.97，95%CI0.95-0.99，P=0.004）。有512例（13.5%）移植前抑郁症患者和3274例（86.5%）无抑郁症患者接受了自体HCT。自体HCT的移植前抑郁与OS无关（HR=1.15，95%CI0.98-1.34，P=0.096），但与存活和出院天数减少相关（MR=0.98，95%CI0.97-0.99，P=0.002）。移植前抑郁与同种异体HCT受者中较低的OS和较高的急性GVHD风险相关，并且在自体和同种异体HCT后的前100天内存活和出院天数较少。移植前抑郁症患者代表了移植后并发症风险的脆弱人群。
To evaluate the impact of depression prior to autologous and allogeneic HCT on clinical outcomes post-transplant. We analyzed data from the Center for International Blood and Marrow Transplant Research to compare outcomes after autologous (n=3786) or allogeneic (n=7433) HCT for adult patients with hematologic malignancies with an existing diagnosis of pre-HCT depression requiring treatment vs. those without pre-HCT depression. Using Cox regression models, we compared OS between patients with or without depression. We compared the number of days-alive-and-out-of-the-hospital in the first 100 days post-HCT using Poisson models. We also compared the incidence of grade II-IV acute and chronic GVHD in allogeneic HCT. 1116 (15%) patients with pre-transplant depression and 6317 (85%) without depression underwent allogeneic HCT in 2008-2012 were included. Pre-transplant depression was associated with lower OS (HR=1.13, 95%CI1.04-1.23, P=0.004) and higher incidence of grade II-IV acute GVHD (HR=1.25, 95%CI 1.14-1.37, P<0.0001), but similar incidence of chronic GVHD. Pre-transplant depression was associated with fewer days alive and out-of-the hospital (Means-Ratio (MR)=0.97, 95%CI0.95-0.99, P=0.004). There were 512 (13.5%) patients with pre-transplant depression and 3274 (86.5%) without depression who underwent autologous HCT. Pre-transplant depression in autologous HCT was not associated with OS (HR=1.15, 95%CI0.98-1.34, P=0.096), but was associated with fewer days-alive-and-out-of-the-hospital (MR=0.98, 95%CI0.97-0.99, P=0.002). Pre-transplant depression was associated with lower OS and higher risk of acute GVHD among allogeneic HCT recipients, and fewer days-alive-and-out-of-the-hospital during the first 100 days after autologous and allogeneic HCT. Patients with pre-transplant depression represent a vulnerable population at risk for post-transplant complications.