Patterns of Symptom Burden in Autologous and Allogeneic Hematopoietic Stem Cell Transplantation.
Authors: Williams Loretta A , Anderson Karen O , Wang Xin Shelley , Cleeland Charles S , Mendoza Tito R , Mobley Gary M , Brown Jane O , Giralt Sergio 
Published: October 2019

Abstract
Abstract 1396
Poster Board I-418

Introduction:
Hematopoietic stem cell transplantation (HSCT) is an intensive therapy that may cure or control a variety of hematological malignancies. Although the toxicities associated with HSCT are well-described, patient report of symptom burden is rarely addressed. Lack of understanding of symptoms may result in failure to address symptoms and return patients to optimum functioning. Differences in the pattern of symptom burden between autologous (auto) and allogeneic (allo) HSCT and the special needs for symptom management that each type of therapy may require has not been addressed. The purpose of this study was to compare the symptom burden of patients undergoing allo- and auto-HSCT.

Patients and Methods:
Retrospective analysis of a combined data set of 155 patients from 3 longitudinal studies exploring the symptom burden of HSCT. Patients used modified versions of the M. D. Anderson Symptom Inventory (MDASI) to rate the severity of their symptoms (13 items) and the degree to which their symptoms interfered with daily living (6 items) on a 0–10 scale. Patients completed the MDASI at baseline, during conditioning therapy, on day of transplant, twice weekly for 4 weeks, and 1 to 2 times weekly for another 10 weeks. Symptom burden was measured as the area under the curve (AUC) of the mean MDASI symptom severity from baseline to 14 weeks post-HSCT.

Results:
Average age of the allo-HSCT patients was 52.9 years, whereas the auto-HSCT patients averaged 53.2 years. The allo- and auto-HSCT patients were 57% and 69% male, respectively, and 73% and 82% Caucasian, respectively. All allo-HSCT patients were being treated for acute myelogenous leukemia/myelodyspalastic syndrome; 66% of the auto-HSCT patients had multiple myeloma and 26% had non-Hodgkin's lymphoma. All allo-HSCT patients received short-course methotrexate as part of their graft-versus-host disease (GVHD) prophylaxis. Symptom severity peaked during the Week 1 post-HSCT for the auto-HSCT patients and Week 2 for the allo-HSCT patients. Three of the most severe symptoms experienced by both groups were lack of appetite, fatigue, and physical weakness. Other most severe symptoms experienced by the auto-HSCT patients were feeling physically sick and nausea. The other most severe symptoms reported by the allo-HSCT patients were pain and difficulty sleeping. Figure 1 shows the symptom burden of the 7 most severe symptoms combined for the two groups. Peak symptom severity was highest for the auto-HSCT group, but the overall AUC and symptom burden was greater for the allo-HSCT group because they remained more symptomatic throughout the 14 weeks of the study, whereas the auto-HSCT patients had returned to baseline levels by the end of 8 weeks. Although sore mouth was not one of the most severe symptoms, the auto-HSCT patients reported significantly more sore mouth during Week 1 post-HSCT (p ≤ 0.002), whereas the allo-HSCT patients reported significantly more sore mouth the second week (p ≤ 0.001). During Week 2, pain severity was significantly greater for the allo-HSCT patients than for the auto-HSCT patients (p ≤ 0.001), while diarrhea was significantly more severe for the auto-HSCT patients than for the allo-HSCT patients (p ≤ 0.001).

Conclusions:
Although patients undergoing auto-HSCT experience more severe acute symptoms from the conditioning regimen, they return to baseline symptom levels several weeks after HSCT. Allo-HSCT patients experience a slightly later peak in symptoms, mostly likely due to the effects of GVHD methotrexate prophylaxis, and continue to experience increased symptom burden up to 3 months post-HSCT, likely due to the development of GVHD and infection complications.

Disclosures:
No relevant conflicts of interest to declare.