Resolved versus Active Chronic Graft-versus-Host Disease: Impact on Post-Transplantation Quality of Life

Saiko Kurosawa; Takuhiro Yamaguchi; Kumi Oshima; Atsumi Yanagisawa; Takahiro Fukuda; Heiwa Kanamori; Takehiko Mori; Satoshi Takahashi; Tadakazu Kondo; Akio Kohno; Koichi Miyamura; Yukari Umemoto; Takanori Teshima; Shuichi Taniguchi; Takuya Yamashita; Yoshihiro Inamoto; Yoshinobu Kanda; Shinichiro Okamoto; Yoshiko Atsuta

doi:10.1016/j.bbmt.2019.05.016

Resolved versus Active Chronic Graft-versus-Host Disease: Impact on Post-Transplantation Quality of Life

Biol Blood Marrow Transplant. 2019 Sep;25(9):1851-1858. doi: 10.1016/j.bbmt.2019.05.016. Epub 2019 May 24.

Authors

Saiko Kurosawa¹, Takuhiro Yamaguchi², Kumi Oshima³, Atsumi Yanagisawa⁴, Takahiro Fukuda⁵, Heiwa Kanamori⁶, Takehiko Mori⁷, Satoshi Takahashi⁸, Tadakazu Kondo⁹, Akio Kohno¹⁰, Koichi Miyamura¹¹, Yukari Umemoto¹², Takanori Teshima¹³, Shuichi Taniguchi¹⁴, Takuya Yamashita¹⁵, Yoshihiro Inamoto⁵, Yoshinobu Kanda¹⁶, Shinichiro Okamoto⁷, Yoshiko Atsuta¹⁷

Affiliations

¹ Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan. Electronic address: skurosaw@ncc.go.jp.
² Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan.
³ Department of Hematology, Jyoban Hospital, Tokiwa Foundation, Fukushima, Japan.
⁴ Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.
⁵ Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
⁶ Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan.
⁷ Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
⁸ Department of Hematology and Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
⁹ Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
¹⁰ Department of Hematology and Oncology, JA Aichi Konan Kosei Hospital, Konan, Japan.
¹¹ Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
¹² Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
¹³ Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
¹⁴ Department of Hematology, Toranomon Hospital, Tokyo, Japan.
¹⁵ Department of Hematology, St. Luke's International Hospital, Tokyo, Japan.
¹⁶ Division of Hematology, Jichi Medical University, Tochigi, Japan.
¹⁷ Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.

PMID: 31129353
DOI: 10.1016/j.bbmt.2019.05.016

Abstract

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-HCT). 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 pretransplantation 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.

Keywords: Allogeneic hematopoietic cell transplantation; Chronic graft-versus-host disease; Long-term follow-up; Quality of life.

Publication types

Clinical Trial
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Allografts
Chronic Disease
Follow-Up Studies
Graft vs Host Disease*
Hematopoietic Stem Cell Transplantation*
Humans
Middle Aged
Quality of Life*
Registries*
Retrospective Studies
Time Factors