Abstract
Studies investigating association of depression with overall survival (OS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) yielded conflicting results. A nationwide cohort study, which included all adult patients [n = 7,170; depression group, 13.3% (N = 956); non-depression group, 86.7% (N = 6,214)] who received allo-HSCT from 2002 to 2018 in South Korea, analyzed risk of pre-transplant depression in OS of allo-HSCT. Subjects were followed from the day they received allo-HSCT, to occurrence of death, or last follow-up day (December 31, 2018). Median age at allo-HSCT for depression and non-depression groups were 50 and 45 (p < 0.0001), respectively. Two groups also differed in rate of females (depression group, 55.8%; non-depression group, 43.8%; p < 0.0001) and leukemia (depression group, 61.4%; non-depression group, 49.7%; p < 0.0001). After a median follow-up of 29.1 months, 5-year OS rate was 63.1%. Cox proportional-hazard regression evaluated an adjusted risk of post-transplant mortality related to depression: OS decreased sequentially from no depression (adjusted hazard ratio [aHR] = 1) to pre-transplant depression only (aHR = 1.167, CI: 1.007–1.352, p = 0.04), and to having both depression and anxiety disorder (aHR = 1.202, CI: 1.038–1.393, p = 0.014) groups. Pre-transplant anxiety (anxiety only) did not have significant influence in OS. Additional medical and psychiatric care might be necessary in patients who experienced depression, especially with anxiety, before allo-HSCT.
Highlights
Allogeneic hematopoietic stem cell transplantation provides curative therapy for patients with malignant and nonmalignant hematologic disorders[1,2]
Our results showed that pre-transplant depression, independent from anxiety, decreased overall survival (OS) of adult patients receiving allo-HSCT
We showed that co-occurrence of depression with anxiety disorder further decreased post-transplant OS, but pre-transplantation anxiety disorder did not independently increase mortality after allo-HSCT
Summary
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) provides curative therapy for patients with malignant and nonmalignant hematologic disorders[1,2]. The Hematopoietic cell transplantation-specific comorbidity index (HCT-CI), one of the most important prognostic scoring systems in allo-HSCT, acknowledged that depression increases post-transplant mortality with hazard ratio of 1.811. Studies investigating the impact of pre-transplant depression on overall survival (OS) of patients receiving allo-HSCT have yielded conflicting r esults[12,13]. A more recent study showed that, among 190 patients receiving allo-HSCT, depression before transplantation predicted higher 1-year (hazard ratio [HR] = 2.59; p = 0.014) and 3-year mortality (HR = 2.04; 95% p = 0.041)[15]. CIBMTR is an US based registry, so studies containing a large sample size must be repeated in diverse ethnicities to confirm impact of pre-transplant depression in outcomes of allo-HSCT
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