Long-Term Follow-up Shows Good QOL After Allo Transplant

SAN DIEGO--Researchers at the Fred Hutchinson Cancer Research Center, Seattle, have been monitoring the institution’s transplant patients for quality of life (QOL) for more than two decades, Keith Sullivan, MD, of the Department of Medical Oncology, said at the Sixth International Symposium on Recent Advances in Hematopoietic Stem Cell Transplantation, sponsored by the University of California, San Diego.

More than 2,500 Hutchinson transplant patients are actively being followed in several ways, he said.

On-site examinations are conducted at the first transplant anniversary and various anniversaries thereafter. The exams include detailed medical, hematologic, and immunologic evaluations.

Questionnaires are sent to referring physicians at 6 months and then at each anniversary.

Patients are sent a questionnaire each year that asks questions about functional performance, symptoms, and medical complications.

With this system, Dr. Sullivan said, all but 4% to 8% of surviving patients have been contacted for updates within the last 2 years.

While recent studies of former transplant patients have reported that most survivors do relatively well, many of these cross-sectional studies have been limited by such things as a follow-up of less than 5 years, limited scope, and small sample size. Hutchinson researchers have tried to fill in this gap.

Long-Term Survivors

One study, headed by Dr. Nigel Bush, scrutinized the quality of life of long-term transplant survivors. Participants in the study had survived a mean of 10 years since transplantation. Some had their transplant as far back as 18 years ago. Of the 125 patients, 87% had an allogeneic transplant and the rest autologous. One measurement used in the study was a 270-item survey that took patients about 90 minutes to complete.

Overall, the news from this research was quite good. "In general, the severity of complaints was low," Dr. Sullivan observed. "Eighty percent listed their current quality of life as good to excellent, while 5% listed it as poor."

Although there were lingering complaints of such problems as fatigue, sexual dysfunction, and sleep disturbances, most survivors considered these to be of low severity, and 88% said the benefits of transplant outweighed the side effects.

Return to Normal Functioning

In another Hutchinson study, Dr. Karen Syrjala and colleagues prospectively analyzed 67 adults before and after allogeneic transplantation. Physical function was most impaired at 90 days after transplant, and most patients had returned to their normal functioning by 1 year. Two years after transplantation, 68% had returned to full-time work, and only 9% still had not done so by the fourth transplant anniversary.

Before the transplant, 27% of patients complained of depression, while 41% experienced anxiety. These numbers did not change the first year after the transplant. Persons who were single or had experienced family conflict before the cancer were more likely to experience greater emotional distress a year after transplantation. A patient was more likely to bounce back if he or she enjoyed a strong family relationship.