Resolved versus Active Chronic Graft-versus-Host Disease: Impact on Post-Transplantation Quality of Life
Resolved versus Active Chronic Graft-versus-Host Disease: Impact on Post-Transplantation Quality of Life
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DOI：
10.1016/j.bbmt.2019.05.016
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发表时间：
2019-09-01
影响因子：
4.3
通讯作者：
Atsuta, Yoshiko
中科院分区：
文献类型：
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作者：
Kurosawa, Saiko;Yamaguchi, Takuhiro;Atsuta, Yoshiko
本研究的目的是确定异基因造血细胞移植（allo-FICT）后慢性移植物抗宿主病（GVHD）消退的患者的生活质量（QOL）是否持续受损。合格的参与者是在allo-HCT后3年内无复发的患者，在移植时年龄>= 16岁，在调查时年龄>= 20岁且无复发。使用医疗结局研究的36项简式调查（SF-36）、癌症治疗功能评估-骨髓移植（FACT-BMT）和视觉模拟量表（VAS）来评估QOL。医生使用美国国立卫生研究院（NIH）标准评估慢性GVHD的现状，并从国家移植登记数据库中提取移植前特征和GVHD病史。目前没有活动性GVHD但有慢性GVHD病史的患者被归类为“消退的GVHD”。在1250名被告知这项研究的患者中，1216名提供了同意书，1130名被纳入最终分析。在allo-HCT后，共有745例患者（66%）目前患有活动性慢性GVHD，149例（13%）慢性GVHD已消退，236例（21%）从未患有慢性GVHD。多变量分析显示，与慢性GVHD缓解或未缓解的患者相比，慢性GVHD活动性患者的生活质量明显较差。慢性GVHD和非慢性GVHD患者的QOL评分相似。年龄≥ 50岁的患者中，SF-36身体成分和VAS评分的组间差异较大，但差异无统计学意义。我们的数据表明，只有目前活跃的慢性GVHD对allo-HCT幸存者的身体、精神和社会生活质量有显著影响，而以前的慢性GVHD如果已经解决，则不会损害生活质量。(C)2019年美国移植和细胞治疗学会。爱思唯尔公司出版
The aim of this study was to determine whether impaired quality of life (QOL) persisted among patients who experienced resolved chronic graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation (allo-FICT). Eligible participants were patients who were relapse-free for 3 years after allo-HCT who were age >= 16 years at the time of transplantation and age >= 20 years without relapse at the time of the survey. The Medical Outcomes Study's 36-Item Short-Form Survey (SF-36), the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), and a visual analog scale (VAS) were administered to assess QOL. Physicians evaluated the current status of chronic GVHD at survey using National Institutes of Health (NIH) criteria, and pre-transplantation characteristics and history of GVHD were extracted from the national transplant registry database. Patients without currently active GVHD but with a history of chronic GVHD were categorized as having "resolved GVHD." Of 1250 patients informed of the study, 1216 provided consent and 1130 were included in the final analysis. A total of 745 patients (66%) had currently active chronic GVHD, 149 (13%) had resolved chronic GVHD, and 236 (21%) never had chronic GVHD after allo-HCT. Multivariable analyses showed that compared with patients with resolved or no chronic GVHD, those with active chronic GVHD reported significantly poorer QOL. The QOL scores were similar in patients with resolved chronic GVHD and those without chronic GVHD. Greater between-group differences were observed in SF-36 Physical component and VAS scores in patients age >= 50 years, but the differences were not statistically significant. Our data indicate that only currently active chronic GVHD has a significant impact on physical, mental, and social QOL in allo-HCT survivors, whereas previous chronic GVHD does not impair QOL if it has been resolved. (C) 2019 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.