Work

Retrospective Analysis of Survival after Allogeneic Bone Marrow Transplantation in Adult Patients with High-Risk Psychosocial Characteristics

Year: 2017

Type: article

Abstract: Background: Allogeneic stem cell transplant (SCT) comes with physically and psychologically distressing symptoms, and post-transplant survival depends on disease features as well as physical, psychological, and behavioral variables. At UNC Hospital, patients perceived as high-risk for SCT can be referred by any member of the clinical team to a monthly Complex Case Conference (CCC). In this study, we tested for an association between identification of patients at high risk of complications and overall survival and evaluated if the validated Transplant Evaluation Rating Scale (TERS) could be used to identify such patients. Methods: We retrospectively assessed 117 adult patients (median age 53, males 61%) who underwent allogeneic SCT at UNC Hospital between 2/1/2014 and 1/31/2016. All patients were scored utilizing the 10-item TERS, based on written psychosocial evaluations performed pre-transplant by clinical staff. Results: At a median (range) follow-up of 422 (139-826) days for all survivors, 13 (72%) CCC patients had died, compared to 41 (41%) patients who were not referred (Figure 1) with a median time to death of 107 days (CCC) vs 163 days (P = .12). Baseline characteristics of the two groups are shown (Table 1). In univariate analysis, presentation to CCC (HR = 2.26, P = .02), R-DRI score (HR = 1.85, P = .003) and HCT-CI (HR = 1.38, P = < .001) were the strongest predictors of inferior survival (OS). A higher Total TERS score (HR = 1.04, P = .0084) also increased risk of death. Among the TERS subcategories, the absence of an Axis I disorder (HR = .39, P = .006) and presence of adequate coping skills (HR = .40, P = .0043) were associated with decreased mortality.Table 1Patient CharacteristicsVariableYes ConferenceN = 18No ConferenceN = 99P-ValueHCT-CI score, median43HCT-CI score.080-24(22%)43(43%)>/= 314(78%)56(57%)R-DRI<.0001Low-Int6(33%)58(59%)High-Very high10(56%)29(29%)NA1(6%)8(8%)Donor HLA match.0610/10 or 8/816(89%)79(80%)9/10 or 7/81(6%)14(14%)Haplo(5/10 or 4/8)1(6%)4(4%)Cord(4/6)02(2%)Diagnosis<.0001Acute Leukemia/MDS16(89%)69(70%)Other2(11%)30(30%)TERS Score, median(range)45(26.5-60.5)26.5(26.5-53)<.0001Median follow-up of survivors, days(range)476(185-601)400(139-826).86 Open table in a new tab Conclusions: These results suggest subjective risk assessments for referral to CCC did predict patients at high risk of poor outcomes. These assessments are, in part, driven by psychosocial factors and reiterate the importance of psychosocial factors on OS in HCT. Beyond the subjective risk assessment, this study shows that high TERS scores are associated with patients at increased risk of post-SCT mortality. Future work should be done to formalize the scoring of patients utilizing the TERS instrument to identify modifiable psychosocial risks prior to SCT to improve transplant outcomes.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2016.12.394