Quality of Life Post Hematopoietic Stem Cell Transplantation for Pediatric Acute Leukemia in Mainland China
Authors: Luo Yanhui , Zhou Xuan , Zheng Huyong , Wang Bin , Qin Maoquan , Sun Yuan , Wang Aihua , Chang Ying , Wu Minyuan , Pan Yuesong 
Published: October 2019

Abstract

Objective
To evaluate the quality of life (QOL) post hematopoietic stem cell transplantation (HSCT) for pediatric acute leukemia patients in mainland China. To analyze the influence factors of children’s QOL and compare the QOL between HSCT group and non-HSCT group.

Methods
Sixty 2-18 years old acute leukemia patients who received HSCT and got more than 4 months survival from June 2009 to June 2012 were recruited from two hematology centers in Beijing. For comparison, the non-HSCT survivors of pediatric acute leukemia were matched as closely as possible for onset age, gender, primary disease and time since treatment with the HSCT group. PedsQLTM Cancer Module 3.0 Chinese mandarin version were completed by both Parents and patients (8-18 years old) or by parents only (for 2-7 years old patients). Clinical data and family information were extracted from medical records and Family Information Table.

Results
1. Forty-nine eligible patients consented to participate and completed the questionnaires (34 boys and 15 girls). The mean age was 9.94-year-old (SD=4.24). The range of time since treatment was 11-115months (median=34), while the range of time since transplantation was 4-43months (median=21).
2. The mean score of overall QOL for HSCT group was about 70 (out of 100), while the mean score in physiological function was about 90.
3. The disease status before transplantation and the education level of patient’s mother were the influence factors of children’s QOL post HSCT : CR2 status and the lower education level of mother result in worse QOL.
4. Some factors could affect a dimension score.
1) Age: the psychological function of adolescent was impaired heavier than the younger patients, mainly in worrying about the side effects of the treatment, the therapeutic effect and the possibility of relapse;
2) Time since HSCT: the children’s evaluation of their own appearance improved 6 months post HSCT, and their gastrointestinal function and cognitive function improved18 months post HSCT.
3) Medicine : the medicine could influence gastrointestinal function of patients at the beginning, but it would disappear and the gastrointestinal function would improve after drug withdrawal;
4) Family income: patients in higher-income families got better physiological function and less worry about the therapeutic effect.
5. Neither gender, diagnosis, donor sources, GVHD (slight), late effects of HSCT, parents’ job, education level of father, nor home area influenced QOL significantly.
6. QOL of HSCT group was significantly lower compared with the non-HSCT group, and the dropout rate was higher.

Conclusion
This is the first report of QOL in pediatric acute leukemia patients post HSCT in mainland China. Datas showed that the overall QOL for HSCT patients was above the median level, with good physiological function. CR2 status and the lower education level of mother result in worse QOL. Age , time since HSCT, medicine and the family income could also affect a dimension score. Neither gender, diagnosis, donor sources, GVHD (slight), late effects of HSCT, patents’ job, education level of father, nor home area influenced QOL significantly. However, QOL of HSCT group was significantly lower and the dropout rate was significantly higher while compared with the non-HSCT group. Further work need to be done to improve the patient’s QOL post transplantation in mainland China.

Disclosures:
No relevant conflicts of interest to declare.