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Impact of pre‐transplant depression on outcomes of allogeneic and autologous hematopoietic stem cell transplantation
Author(s) -
ElJawahri Areej,
Chen YiBin,
Brazauskas Ruta,
He Naya,
Lee Stephanie J.,
Knight Jennifer M.,
Majhail Navneet,
Buchbinder David,
Schears Raquel M.,
Wirk Baldeep M.,
Wood William A.,
Ahmed Ibrahim,
Aljurf Mahmoud,
Szer Jeff,
Beattie Sara M.,
Battiwalla Minoo,
Dandoy Christopher,
Diaz MiguelAngel,
D'Souza Anita,
Freytes Cesar O.,
Gajewski James,
Gergis Usama,
Hashmi Shahrukh K.,
Jakubowski Ann,
Kamble Rammurti T.,
KindwallKeller Tamila,
Lazarus Hilard M.,
Malone Adriana K.,
Marks David I.,
Meehan Kenneth,
Savani Bipin N.,
Olsson Richard F.,
Rizzieri David,
Steinberg Amir,
Speckhart Dawn,
Szwajcer David,
Schoemans Helene,
Seo Sachiko,
Ustun Celalettin,
Atsuta Yoshiko,
Dalal Jignesh,
SalesBonfim Carmem,
Khera Nandita,
Hahn Theresa,
Saber Wael
Publication year - 2017
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30546
Subject(s) - medicine , transplantation , hematopoietic stem cell transplantation , stem cell , depression (economics) , hematopoietic cell , haematopoiesis , oncology , intensive care medicine , surgery , genetics , biology , macroeconomics , economics
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 . © 2017 American Cancer Society .