Pre-Transplant Depression in HCT Patients May Worsen Outcomes
Pre-transplant depression tied to lower overall survival, higher risk of acute GVHD in allogeneic HCT
HealthDay News — For adult patients undergoing hematopoietic cell transplantation (HCT), pre-transplant depression is associated with worse post-transplantation outcomes, according to a study published online in Cancer.
Areej El-Jawahri, MD, from the Massachusetts General Hospital in Boston, and colleagues analyzed data from the Center for International Blood and Marrow Transplant Research (CIMBTR) to compare outcomes for adult patients with hematologic malignancies with and without depression after autologous (3786 patients) or allogeneic (7433 patients) HCT.
The researchers found that among patients who underwent allogeneic HCT between 2008 and 2012, 15 and 85 percent, respectively, had pre-transplant depression and no depression. Pre-transplant depression correlated with lower overall survival (hazard ratio, 1.13; 95 percent confidence interval [CI], 1.04 to 1.23; P = 0.004) and with increased incidence of grade 2 to 4 acute graft-versus-host disease (hazard ratio, 1.25; 95 percent CI, 1.14 to 1.37; P < 0.0001). There was a correlation for pre-transplant depression with fewer days alive and out of the hospital (means ratio, 0.97; 95 percent CI, 0.95 to 0.99; P = 0.004). Among patients who underwent autologous HCT, 13.5 and 86.5 percent, respectively, had pre-transplant depression and were without depression. In autologous HCT, pre-transplant depression was not associated with overall survival (hazard ratio, 1.15; 95 percent CI, 0.98 to 1.34; P = 0.096), but there was a correlation with fewer days alive and out of the hospital (means ratio, 0.98; 95 percent CI, 0.97 to 0.99; P = 0.002).
"Patients with pre-transplant depression represent a population that is at risk for post-transplant complications," the authors write.
The CIBMTR was partially funded by several pharmaceutical companies.
Several authors disclosed financial ties to the pharmaceutical and nutrition industries.
El-Jawahri A, Chen YB, Brazauskas R, He N, et al. Impact of pre-transplant depression on outcomes of allogeneic and autologous hematopoietic stem cell transplantation [published online January 19, 2017]. Cancer. doi: 10.1002/cncr.30546. [Epub ahead of print]