Areej El-Jawahri1, Yi-Bin Chen1, Ruta Brazauskas2,3, Naya He2, Stephanie J Lee4, Jennifer M Knight2, Navneet Majhail5, David Buchbinder6, Raquel M Schears7, Baldeep M Wirk8, William A Wood9, Ibrahim Ahmed10, Mahmoud Aljurf11, Jeff Szer12, Sara M Beattie13, Minoo Battiwalla14, Christopher Dandoy15, Miguel-Angel Diaz16, Anita D'Souza2, Cesar O Freytes17, James Gajewski18, Usama Gergis19, Shahrukh K Hashmi7, Ann Jakubowski20, Rammurti T Kamble21, Tamila Kindwall-Keller22, Hilard M Lazarus23, Adriana K Malone24, David I Marks25, Kenneth Meehan26, Bipin N Savani27, Richard F Olsson28,29, David Rizzieri30, Amir Steinberg31, Dawn Speckhart32, David Szwajcer33, Helene Schoemans34, Sachiko Seo35, Celalettin Ustun36, Yoshiko Atsuta37,38, Jignesh Dalal10, Carmem Sales-Bonfim39, Nandita Khera40, Theresa Hahn41, Wael Saber2. 1. Massachusetts General Hospital, Boston, Massachusetts. 2. Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin. 3. Medical College of Wisconsin, Milwaukee, Wisconsin. 4. Fred Hutchinson Cancer Research Center, Seattle, Washington. 5. Cleveland Clinic, Cleveland, Ohio. 6. Children's Hospital of Orange County, Orange, California. 7. Brandeis University, Waltham, Massachusetts. 8. Seattle Cancer Care Alliance, Seattle, Washington. 9. University of North Carolina, Chapel Hill, North Carolina. 10. The Children's Mercy Hospitals and Clinics, Kansas City, Missouri. 11. King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia. 12. Royal Melbourne Hospital, Victoria, Australia. 13. University of Ottawa, Ottawa, Ontario, Canada. 14. National Heart, Lung, and Blood Institute, Bethesda, Maryland. 15. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 16. Hospital Infantil Universitario Nino Jesus, Madrid, Spain. 17. University of Texas Health Science Center San Antonio, San Antonio, Texas. 18. Oregon Health and Science University, Portland, Oregon. 19. New York Presbyterian Hospital, New York, New York. 20. Memorial Sloan-Kettering Cancer Center, New York, New York. 21. Baylor College of Medicine, Houston, Texas. 22. University of Virginia Health System, Charlottesville, Virginia. 23. Seidman Cancer Center, Cleveland, Ohio. 24. Tisch Cancer Institute, New York, New York. 25. University Hospitals Bristol NHS Trust, Bristol, United Kingdom. 26. Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire. 27. Vanderbilt University Medical Center, Nashville, Tennessee. 28. Karolinska Institute, Stockholm, Sweden. 29. Uppsala University, Uppsala, Sweden. 30. Duke University, Durham, North Carolina. 31. Mount Sinai Hospital, New York, New York. 32. Northside Hospital, Atlanta, Georgia. 33. University of Manitoba, Winnipeg, Manitoba, Canada. 34. University Hospital of Leuven, Leuven, Belgium. 35. East Hospital, Kashiwa, Chiba, Japan. 36. University of Minnesota Medical Center, Minneapolis, Minnesota. 37. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan. 38. Nagoya University Graduate School of Medicine, Nagoya, Japan. 39. Hospital de Clinicas, Federal University of Parana, Curitiba, Brazil. 40. Mayo Clinic, Phoenix, Arizona. 41. Roswell Park Cancer Institute, Buffalo, New York.
Abstract
BACKGROUND: To evaluate the impact of depression before autologous and allogeneic hematopoietic cell transplantation (HCT) on clinical outcomes post-transplantation. METHODS: We analyzed data from the Center for International Blood and Marrow Transplant Research to compare outcomes after autologous (n = 3786) or allogeneic (n = 7433) HCT for adult patients with hematologic malignancies with an existing diagnosis of pre-HCT depression requiring treatment versus those without pre-HCT depression. Using Cox regression models, we compared overall survival (OS) between patients with or without depression. We compared the number of days alive and out of the hospital in the first 100 days post-HCT using Poisson models. We also compared the incidence of grade 2-4 acute and chronic graft-versus-host disease (GVHD) in allogeneic HCT. RESULTS: The study included 1116 (15%) patients with pre-transplant depression and 6317 (85%) without depression who underwent allogeneic HCT between 2008 and 2012. Pre-transplant depression was associated with lower OS (hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.04-1.23; P = 0.004) and a higher incidence of grade 2-4 acute GVHD (HR, 1.25; 95% CI, 1.14-1.37; P < 0.0001), but similar incidence of chronic GVHD. Pre-transplant depression was associated with fewer days-alive-and-out-of-the hospital (means ratio [MR] = 0.97; 95% CI, 0.95-0.99; P = 0.004). There were 512 (13.5%) patients with Pre-transplant depression and 3274 (86.5%) without depression who underwent autologous HCT. Pre-transplant depression in autologous HCT was not associated with OS (HR, 1.15; 95% CI, 0.98-1.34; P = 0.096) but was associated with fewer days alive and out of the hospital (MR, 0.98; 95% CI, 0.97-0.99; P = 0.002). CONCLUSION: Pre-transplant depression was associated with lower OS and higher risk of acute GVHD among allogeneic HCT recipients and fewer days alive and out of the hospital during the first 100 days after autologous and allogeneic HCT. Patients with pre-transplant depression represent a population that is at risk for post-transplant complications. Cancer 2017;123:1828-1838.
BACKGROUND: To evaluate the impact of depression before autologous and allogeneic hematopoietic cell transplantation (HCT) on clinical outcomes post-transplantation. METHODS: We analyzed data from the Center for International Blood and Marrow Transplant Research to compare outcomes after autologous (n = 3786) or allogeneic (n = 7433) HCT for adult patients with hematologic malignancies with an existing diagnosis of pre-HCT depression requiring treatment versus those without pre-HCT depression. Using Cox regression models, we compared overall survival (OS) between patients with or without depression. We compared the number of days alive and out of the hospital in the first 100 days post-HCT using Poisson models. We also compared the incidence of grade 2-4 acute and chronic graft-versus-host disease (GVHD) in allogeneic HCT. RESULTS: The study included 1116 (15%) patients with pre-transplant depression and 6317 (85%) without depression who underwent allogeneic HCT between 2008 and 2012. Pre-transplant depression was associated with lower OS (hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.04-1.23; P = 0.004) and a higher incidence of grade 2-4 acute GVHD (HR, 1.25; 95% CI, 1.14-1.37; P < 0.0001), but similar incidence of chronic GVHD. Pre-transplant depression was associated with fewer days-alive-and-out-of-the hospital (means ratio [MR] = 0.97; 95% CI, 0.95-0.99; P = 0.004). There were 512 (13.5%) patients with Pre-transplant depression and 3274 (86.5%) without depression who underwent autologous HCT. Pre-transplant depression in autologous HCT was not associated with OS (HR, 1.15; 95% CI, 0.98-1.34; P = 0.096) but was associated with fewer days alive and out of the hospital (MR, 0.98; 95% CI, 0.97-0.99; P = 0.002). CONCLUSION: Pre-transplant depression was associated with lower OS and higher risk of acute GVHD among allogeneic HCT recipients and fewer days alive and out of the hospital during the first 100 days after autologous and allogeneic HCT. Patients with pre-transplant depression represent a population that is at risk for post-transplant complications. Cancer 2017;123:1828-1838.
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