Age Does Not Influence Long-Term Quality of Life (QOL) after Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for AML/MDS.
Authors: Shahjahan Munir , Alamo Jorge , Giralt Sergio , Detry Michelle , Munsell Mark , Estey Elihu , Champlin Richard , de Lima Marcos 
Published: October 2019

Abstract
Allogeneic HSCT has the potential to cure patients with AML or MDS, but is associated with significant morbidity and complications that can affect the QOL of survivors. We examined QOL of AML/MDS patients surviving 2 years or more in remission after allo HSCT, including physical, psychosocial and functional well being.
OBJECTIVES: We seek to describe QOL of long-term survivors (LTS) with AML/MDS and to compare QOL as a function of age at transplant.
METHODS: Long-term survivorship was defined as survival in remission beyond 2 years from HSCT; 2 years was chosen given the stabilization of the failure rate on the 3rd year after HSCT. There were 544 adult AML/MDS patients treated with allogeneic HSCT between January 1976 and September 2001. Of these, 129 (24%) were in remission for at least 2 years and were eligible for the study. QOL was assessed using the standardized Functional Assessment of Cancer Therapy-BMT (FACT-BMT) questionnaire that measures multidimensional QOL concepts and consists of 5 subscales measuring physical (PWB), functional (FWB), social/family (SFWB), and emotional well being (EWB), including satisfaction with the doctor-patient relationship (RWD) (McQuellon et al., Bone Marrow Transplant, 1997). There was an additional concern (AC) subscale that asked questions related to job, appetite, body appearance, tiredness, interest in sexual activity etc. FACT-BMT allowed for responses to have values ranging from 0 (not at all) to 4 (very much). Specified QOL questions were recorded so that higher score reflected a higher QOL in the reported dimension. The questionnaire was mailed, and delivery could be confirmed for 121 patients out of whom 82 (68%) responded. Demographic and clinical characteristics were collected from patient charts and clinical database.
RESULTS: Median age at transplant was 38.44 years (range 18.54–68.08). Median time from HSCT to receipt of questionnaire was 4.53 years. Gender: 47 males and 35 females. Diagnosis: AML (n=70) and MDS (n=12). Conditioning regimens were of reduced intensity in 29 cases and myeloablative in 53 cases. Stem cell source: bone marrow (n=52), and peripheral blood (n=30). GVHD prophylaxis: tacrolimus based in 61 cases and cyclosporine based in 18 cases; none in 2 cases. Disease status at HSCT: complete remission (n=40), relapsed (n= 37) and untreated disease (n=5). Median follow-up time was 4.53 years (range 2.0–21.1 yrs). There were no significant differences in QOL scores between the older and younger patients (above and below the median age at transplant) in the PWB, SFWB, EWB, FWB and RWD subscales. In the AC subscale, however, older patients had higher QOL scores than younger patients (mean score 37.97 vs. 33.25, p=0.005). When we compared non-myeloablative (NMA) vs. myeloablative (MA) regimens, there were no significant differences in mean QOL scores in all but the AC subscale where NMA group did better (39.00 vs. 33.34, p=0.001). Acute graft versus host disease (aGVHD) did not impact long-term QOL but lack of chronic GVHD was associated with better QOL score in the PWB, EWB, FWB and AC subscales (PWB: 25.04 vs. 20.62, p=0.005; EWB: 21.77 vs. 18.98, p=0.003; FWB: 22.91 vs. 18.00, p=0.008; and AC: 40.00 vs. 34.28, p=0.002).
CONCLUSIONS: Among LTS with AML/MDS, older age did not affect QOL at a median of 4.5 yrs post HSCT.