Sleep Disruption, Fatigue, and Depression as Predictors of 6-Year Clinical Outcomes Following Allogeneic Hematopoietic Cell Transplantation.
Sleep Disruption, Fatigue, and Depression as Predictors of 6-Year Clinical Outcomes Following Allogeneic Hematopoietic Cell Transplantation.
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睡眠中断、疲劳和抑郁是同种异体造血细胞移植后 6 年临床结果的预测因子。
DOI：
10.1093/jnci/djab032
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Costanzo,ErinS
中科院分区：
文献类型：
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作者：
Rentscher,KellyE;Carroll,JudithE;Juckett,MarkB;Coe,ChristopherL;Broman,AimeeT;Rathouz,PaulJ;Hematti,Peiman;Costanzo,ErinS
异基因造血细胞移植（allogeneic hematopoietic cell transplantation，HCT）是一种广泛应用于血液系统恶性肿瘤的治疗方法，其生存率为25%~ 78%。慢性移植物抗宿主病（cGVHD）是一种严重和常见的长期并发症，HCT后疾病复发和死亡率的已知风险因素已被确定，但HCT结局的大部分变异性无法解释。生物行为症状包括抑郁、睡眠中断和疲劳是患者最普遍和最令人痛苦的症状;但对HCT结局的生物行为风险因素的研究有限。本研究评估患者报告的抑郁症，睡眠中断，疲劳作为cGVHD，疾病复发，和mortality.MethodsAdults接受同种异体HCT的血液恶性肿瘤（N = 241）的危险因素完成自我报告的措施抑郁症状，睡眠质量，疲劳（严重程度，干扰）前HCT和HCT后100天。临床结果监测长达6年。（双尾）调整患者的人口统计学和医学特征显示，高HCT前睡眠中断（匹兹堡睡眠质量指数>9;风险比[HR] = 2.74，95%置信区间[CI] = 1.27 - 5.92）和HCT后疲劳干扰更大（HR = 1.32，95% CI = 1.05 - 1.66）唯一预测死亡风险增加。中度HCT前睡眠中断（匹兹堡睡眠质量指数6-9）预测复发风险增加（HR = 1.99，95%CI = 1.02 - 3.87）。生物行为症状并没有预测cGVHD incidence. ConclusionsBiobiabilistic症状，特别是睡眠中断和疲劳干扰，预测HCT后6年复发和死亡的风险增加。由于这些症状易于治疗，因此它们为干预提供了特定的目标，以改善HCT结果。
BackgroundAllogeneic hematopoietic cell transplantation (HCT) is a widely used treatment for hematologic cancers, with survival rates ranging from 25% to 78%. Known risk factors for chronic graft-versus-host disease (cGVHD), a serious and common long-term complication, disease relapse, and mortality following HCT have been identified, but much of the variability in HCT outcomes is unexplained. Biobehavioral symptoms including depression, sleep disruption, and fatigue are some of the most prevalent and distressing for patients; yet research on biobehavioral risk factors for HCT outcomes is limited. This study evaluated patient-reported depression, sleep disruption, and fatigue as risk factors for cGVHD, disease relapse, and mortality.MethodsAdults receiving allogeneic HCT for a hematologic malignancy (N = 241) completed self-report measures of depression symptoms, sleep quality, and fatigue (severity, interference) pre-HCT and 100 days post-HCT. Clinical outcomes were monitored for up to 6 years.ResultsCox proportional hazard models (2-tailed) adjusting for patient demographic and medical characteristics revealed that high pre-HCT sleep disruption (Pittsburgh Sleep Quality Index >9; hazard ratio [HR] = 2.74, 95% confidence interval [CI] = 1.27 to 5.92) and greater post-HCT fatigue interference (HR = 1.32, 95% CI = 1.05 to 1.66) uniquely predicted increased risk of mortality. Moderate pre-HCT sleep disruption (Pittsburgh Sleep Quality Index 6-9) predicted increased risk of relapse (HR = 1.99, 95% CI = 1.02 to 3.87). Biobehavioral symptoms did not predict cGVHD incidence.ConclusionsBiobehavioral symptoms, particularly sleep disruption and fatigue interference, predicted an increased risk for 6-year relapse and mortality after HCT. Because these symptoms are amenable to treatment, they offer specific targets for intervention to improve HCT outcomes.