Symptom burden in adult survivors of allogeneic hematopoietic stem cell transplantation.
Authors: Moataz Ellithi, Jonathan Trinh, Jonathan Nilles, Krishna Gundabolu, Michael Haddadin, Lori J. Maness, Christopher S. Wichman, Vijaya Raj Bhatt
Journal: Journal of Clinical Oncology (2024)

6557 Background: Progress in allogeneic hematopoietic cell transplantation (HCT) and supportive care has significantly improved transplant outcomes and expanded the number of HCT survivors. A growing responsibility exists to address long-term morbidity and symptom burden. We sought to investigate symptom burden in adult survivors of HCT using a set of validated tools. Methods: We analyzed adults aged 19 years or older with hematologic malignancies who were treated with allogenic HCT at our institution from June 2018 to November 2022. Patients required at least one visit to our survivorship clinic for inclusion. We assessed symptom burden using the National Comprehensive Cancer Network (NCCN) Survivorship Assessment Questionnaire, which is a 25-question survey designed to assesses symptoms related to the following domains: cardiac, mood, cognition, fatigue, lymphedema, hormonal, pain, sexual dysfunction, and sleep. The short physical performance battery (SPPB) and short blessed test were used to assess physical function and conduct cognitive screen, respectively. Finally, we compared scores between patients &lt;60 and ≥60 years old to examine an association between age and post-transplant symptoms. Results: A total of 152 patients have a median age of 61 years (range 21-76); 59.2% were males, and 28.5% had a BMI ≥30. Median Hematopoietic Cell Transplantation-specific Comorbidity Index was 3. The most common indication for transplant was acute myeloid leukemia (48.0%), and the most common donor type was matched unrelated (57.2%). The median time from transplant to the first survivorship clinic visit was 99 days. The most common symptom domains affected, according to the NCCN questionnaire results, were fatigue (50.7%), sleep (45.3%), and cognition (42.0%) whereas the least affected domains were pain (29.5%), cardiac (26.2%), and sexual (19.4%). When we stratified patients by &lt;60 years old and ≥60 years old, we saw similar rates of reported symptoms, particularly regarding sleep disorder (44.3% vs. 45.7%, respectively), mood disturbance (31.4% vs. 34.1%, respectively), and sexual dysfunction (17.9% vs. 20.5%, respectively). Older patients, however, had higher rates of physical impairment according to SPPB scores (50.0% vs. 15.7%, OR = 5.4 [95% CI = 2.2-14.3]). Blessed test showed impaired cognitive screen in 7.2% without a significant difference based on age. Conclusions: Adult survivors of allogeneic HCT at 3-month post-transplant commonly suffer from symptoms across a variety of domains, especially pertaining to fatigue, sleep, and cognition. These symptoms affect both younger and older patients, although older patients are more likely to have physical impairment. The NCCN Survivorship Assessment Questionnaire captures a number of symptoms related to quality of life and can be more widely utilized as a tool to evaluate survivorship symptoms in patients who undergo HCT.