Cancer Therapy-Bone Marrow Transplant Scale Research Articles

Quality of Life following Allogeneic Stem Cell Transplantation for Patients Age >60 Years with Acute Myelogenous Leukemia.

This study of patients with acute myelogenous leukemia (AML) age ≥60 years analyzed the association between patients' performance indices-Hematopoietic Stem Cell Transplantation Comorbidity Index (HCT-CI), Karnofsky Performance Score (KPS), and European Society for Blood and Marrow Transplantation (EBMT) risk score-before undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) and quality of life (QoL), quantified using the Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale (FACT-BMT), in the first year after allo-HSCT. Over a period of 7 years, 48 evaluable patients underwent reduced-intensity conditioning allo-HSCT. The median patient age was 65 years (range, 60 to 74 years), with 2-year and 5-year overall survival (OS) of 65.8% and 52.3%, respectively. A significant improvement across all QoL scores was observed over the 12 months post-HSCT. An HCT-CI of 0 was associated with improved general QoL (FACT-G) score at 6 months compared with patients with an HCT-CI of 1 to 2 (P= .032). At 12 months post-HSCT, a pretransplantation HCT-CI ≥3 was correlated with lower QoL scores across the domains (symptom-related QoL [FACT-TOI], P= .036; FACT-G, P= .05; BMT-related QoL [FACT-BMT], P= .036). A pretransplantation KPS score of 100 versus 80 to 90 was predictive of improved QoL at 6 months post-HSCT (FACT-TOI, P=.009; FACT-G, P= .001; FACT-BMT, P= .002) but not at 1 year post-HSCT. We demonstrate that KPS and HCT-CI can predict QoL in the early post-transplantation period, with a favorable overall survival in a selected cohort of AML patients age ≥60 years.

Comparative effectiveness of busulfan/cyclophosphamide versus busulfan/fludarabine myeloablative conditioning for allogeneic hematopoietic cell transplantation in acute myeloid leukemia and myelodysplastic syndrome

Objective/BackgroundBusulfan/cyclophosphamide (Bu/Cy) and busulfan/fludarabine (Bu/Flu) are both standard myeloablative conditioning (MAC) regimens for allogeneic hematopoietic cell transplantation (alloHCT). We compared the effectiveness of these regimens with a focus on quality of life (QOL). MethodsThis was a single center, retrospective analysis of adult acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) patients who underwent a first T-cell replete HLA-8/8 matched related or unrelated donor alloHCT. Patients received a myeloablative regimen of either parenteral Bu/Cy or Bu/Flu. Outcomes assessed included infections, graft-versus-host-disease (GVHD), relapse, relapse mortality (RM), relapse-free survival (RFS), nonrelapse mortality (NRM), overall survival (OS), and QOL. ResultsFrom 2008 to 2017, 126 AML and 84 MDS adult patients age ≥18 years were identified meeting inclusion criteria. In terms of QOL, there were no significant differences between Bu/Cy and Bu/Flu cohorts in the Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale (FACT-BMT) scores or mucositis severity for either AML or MDS patients. Amongst AML patients, those receiving Bu/Flu had more rapid neutrophil and platelet recovery and a shorter length of hospital stay (LOS); there were no differences in the other posttransplant outcomes. Similarly, amongst MDS patients, those receiving Bu/Flu had more rapid platelet recovery and a shorter LOS as well as more CMV infections, but less NRM and no differences in other outcomes. ConclusionWe confirmed that myeloablative Bu/Flu conditioning has comparable clinical and QOL outcomes to Bu/Cy.

Survival Differences Among Patients (pts) with Acute Myeloid Leukemia (AML) Treated with Allogeneic Hematopoietic Cell Transplantation (HCT) Versus Non-HCT Therapies: A Large Real-Time Multi-Center Prospective Longitudinal Observational Study

Introduction: Survival rates continue to improve after allogeneic HCT (Gooley et al, NEJM, 2013). Population-based studies also indicate overall improvement in survival of older (60-80 years old) AML patients (pts) (Bower, Blood Cancer Journal, 2016). Yet, only a small minority (6%-8%) of them receive HCT (Medeiros, Ann Hematol. 2015). Given these potentially incongruent findings and the changing face of survival in AML, we designed the first prospective multi-center longitudinal study dating from first presentation of adults with AML to be treated at one of 13 different referral centers that provide both AML treatment and HCT. We compared survival according to whether or not pts received HCT at later time points. Methods: We enrolled 695 pts (Table 1). Data on demographics, AML status, cytogenetic risks per European Leukemia Network (ELN), and response; age; comorbidities per the HCT-comorbidity index (CI); function including activities of daily living (ADL); frailty; geriatric assessment including cognition; QOL including the Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale (FACT-BMT), Euro-QOL 5-Dimension scale, ENRICHD Social Support Instrument, Social Activity Log, and Patient Health Questionnaire 9-item Depression Scale (PHQ-9) were collected at enrollment and at 1, 3, 6, 9, 12, 18, and 24 months thereafter. We used time-dependent Cox regression analyses to identify baseline and time-dependent risk factors associated with mortality in the overall population. The factors identified as significantly associated with mortality (p Results: Median follow-up was 16.8 months (range 0.1-52.4). In the initial multivariate analyses, the following were identified as significantly associated with an increased risk of mortality (Table 2): HCT-CI scores ≥5 (p Survival after HCT was 58% at 2-years. Initial unadjusted analyses showed significantly lower risks of mortality in association with receiving allogeneic HCT (p=0.0003). These findings were similar in pts with intermediate (p=0.0005) or unfavorable (p However, in the adjusted models, the advantage of HCT in reducing mortality rates was lost both in the overall population (p=0.21, see figure) as well as in the other groups (p>0.54, 0.40, and 0.51, respectively, Table 3). Formal tests of interactions (Table 3) showed no statistically compelling evidence that the association of HCT and mortality varies with respect to the timing of mortality or to the underlying ELN risk. Conclusions: In a prospective observational study, adjusting for key AML-specific and pt-specific variables negated the observed benefit of HCT over non-HCT therapies in reducing mortality rates among AML pts. Our results might reflect 1) improvement in supportive care and non-HCT therapies, 2) a relatively high non-relapse mortality early after HCT and the need for longer follow-up to demonstrate an adjusted benefit of HCT, and 3) the high selectivity of the transplant eligibility process, as we accounted here for variables that are often ignored in "genetic assignment" randomized studies (i.e. comorbidities and function). New randomized trials are needed; however, these trials have to be more inclusive of vulnerable pts and measure pt-specific variables. Trials focusing on reducing burden of comorbidities, frailty and poor function are needed alongside trials to treat AML with or without HCT. Disclosures Gerds:Celgene: Consultancy; Apexx Oncology: Consultancy; CTI Biopharma: Consultancy; Incyte: Consultancy. Shami:JSK Therapeutics: Employment, Equity Ownership, Membership on an entity9s Board of Directors or advisory committees; Baston Biologics Company: Membership on an entity9s Board of Directors or advisory committees; Lone Star Biotherapies: Equity Ownership; Pfizer: Consultancy. Rizzieri:Teva: Consultancy, Membership on an entity9s Board of Directors or advisory committees, Speakers Bureau; Jazz: Consultancy, Membership on an entity9s Board of Directors or advisory committees; Incyte: Consultancy, Membership on an entity9s Board of Directors or advisory committees, Speakers Bureau; Amgen: Consultancy, Membership on an entity9s Board of Directors or advisory committees; Arog: Consultancy, Membership on an entity9s Board of Directors or advisory committees; Pfizer: Consultancy, Membership on an entity9s Board of Directors or advisory committees; Novartis: Consultancy; Gilead: Consultancy, Membership on an entity9s Board of Directors or advisory committees, Speakers Bureau. Wang:Amgen: Consultancy; Pfizer: Consultancy, Membership on an entity9s Board of Directors or advisory committees; Jazz: Speakers Bureau; Novartis: Speakers Bureau; Novartis: Speakers Bureau; Amgen: Consultancy; Abbvie: Consultancy, Membership on an entity9s Board of Directors or advisory committees; Jazz: Speakers Bureau; Abbvie: Consultancy, Membership on an entity9s Board of Directors or advisory committees; Pfizer: Consultancy, Membership on an entity9s Board of Directors or advisory committees. Faderl:Jazz Pharmaceuticals: Employment, Equity Ownership. Koprivnikar:Alexion: Consultancy, Speakers Bureau; Amgen: Speakers Bureau; Otsuka: Consultancy. Sekeres:Opsona: Membership on an entity9s Board of Directors or advisory committees; Celgene: Membership on an entity9s Board of Directors or advisory committees; Celgene: Membership on an entity9s Board of Directors or advisory committees; Opsona: Membership on an entity9s Board of Directors or advisory committees. Becker:GlycoMimetics: Research Funding.

Evaluation of Quality of Life and Care Needs of Turkish Patients Undergoing Hematopoietic Stem Cell Transplantation.

This descriptive study explored the quality of life and care needs of Turkish patients who underwent hematopoietic stem cell transplantation. The study sample consisted of 100 hematopoietic stem cell transplant patients. Their quality of life was assessed using Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale. The mean patient age was 44.99 ± 13.92 years. Changes in sexual functions, loss of hair, loss of taste, loss of appetite, and sleep disturbances were the most common symptoms. The quality of life of transplant patients was moderately affected; the functional well-being and social/family well-being subscales were the most adversely and least negatively affected (12.13 ± 6.88) dimensions, respectively. Being female, being between 50 and 59 years of age, being single, having a chronic disease, and having a history of hospitalization were associated with lower quality of life scores. Interventions to improve functional status, physical well-being, and emotional status of patients during the transplantation process may help patients cope with treatment-related impairments more effectively. Frequent screening and management of patient symptoms in order to help patients adapt to life following allogeneic hematopoietic stem cell transplantation are crucial for meeting care needs and developing strategies to improve their quality of life.

Quality of Life Survey in Nonmyeloablative Bone Marrow Transplant Patients at a Large Academic Center

Introduction:Patients who undergo hematopoietic stem cell transplant (HCT) experience various qualities of life post-transplant as a consequence of the disease, comorbities and/or transplant-related complications. Reports of post-allotransplant quality of life (QOL) describe those who received myeloablative conditioning. The consequences of the illness and its treatment are often more challenging for a person of advanced age. While less intense nonmyeloablative (NMAT) or reduced-toxicity conditioning permits allotransplantation for older or infirm transplant candidates, such patients also come to transplant with decreased life-expectancy and comordities that may differ from younger recipients. There is scarcity of reports concerning post-NMAT QOL; knowledge in this area would help guide patients in making decisions about their treatment. We sought to study the QOL of survivors of NMAT at the Indiana University (IU) School of Medicine and the IU Simon and Bren Cancer Center.Goal:Document QOL of patients who underwent NMAT for acute myeloid leukemia (AML) or myelodysplasia (MDS) at Indiana University (IU) School of Medicine and the IU Simon and Bren Cancer Center from 2000-2013.Methods:We utilized the Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale (FACT-BMT) which measures the effect of transplant on domains in physical well-being (PWB), social well-being (SWB), emotional well-being (EWB), functional well-being (FWB) along with BMT-specific concerns. Each response is scored between 0 and 4, with 0 being the "not at all true" and 4 being "very much true". There are 37 total questions and the highest possible score is 148, with higher scores corresponding to better QOL. The study was approved by the IRB and the surveys were conducted over the phone following obtainment of consent.Results:Thirty-three consecutive survivors of NMAT were asked to participate in a telephone survey and 27 (82%) agreed to participate. Twelve males and 15 females completed the survey; 2 declined and 4 could not be contacted. Sixteen had undergone transplant for the treatment of MDS and 11 for the treatment of AML. The median age at transplant was 59 years (range, 44-67) and median age at time of interview was 65 years (56-75). The time from transplant ranged from 2 to 15 years. All participants had received identical conditioning (cyclophosphamide, 60mg/m2 x 2 days; fludarabine, 25mg/kg x 5 days) and a variety of graft-versus-host prophylaxis regimens. ECOG performance status at the time of the transplant was 0 (n=22), 1 (n=4) or 2 (n=1). One patient experienced relapse shortly after transplant; all others were in remission.The average total FACT-BMT score for QOL was 120. Mean category-specific scores were as follows: PWB, 22/28; SWB, 25/28; EWB, 20/24; FWB 22/28; BMT-specific concerns, 31/40. Overall, patients scored highest in the SWB category, despite a number of patients lacking a spouse or main support (n=7). Lack of energy was rated the most important problem in the PWB category, with an average score of 2.03. Nausea was rated the least problematic, with an average score of 0.25. In the EWB category, the majority of patients were satisfied with how they were coping with their illness (3.51), and there was surprisingly little concern about dying (0.33). In the FWB category, all but four patients were "quite a bit" to "very much" content with the quality of their life. Twenty-six were able to work at a job or at home at least "somewhat"; 1 was able to work "not at all". In the BMT-specific category, every patient responded "very much" to the query "I have confidence in my nurse."Conclusion:Patients who participated in this single institution study appear to have generally favorable perceptions of their QOL post-NMAT. We found the FACT-BMT tool easy to use in a telephone survey, the level of participation was surprisingly high and the study was accomplished rather quickly with minimal resources. Future efforts will be directed at attempts to correlate QOL with additional transplant outcome variables, such as conditioning intensity, ECOG performance status at transplant and the presence or absence of chronic GVHD. DisclosuresNo relevant conflicts of interest to declare.

Impact of an incentive-based mobility program, "Motivated and Moving," on physiologic and quality of life outcomes in a stem cell transplant population.

Research suggests that patients experience increased fatigue, reduced physical activity, and diminished quality of life (QOL) after hematopoietic stem cell transplantation (HSCT). Structured exercise during hospitalization has been shown to maintain or improve fatigue. Incentive-based interventions have not been tested to encourage physical activity maintenance. The study's aim was to evaluate the effect of participation in an incentive-based mobility program on fatigue, physical conditioning, performance status, and QOL in individuals undergoing allogeneic HSCT. We hypothesized that program participation would affect these variables and that time spent engaged in physical activity would correlate with improved outcomes. A 1-group repeated-measures design used the Brief Fatigue Inventory, 6-minute walk test, and the Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale to assess study variables. Repeated-measures models assessed the effect of participation time on these variables. Individuals with higher participation (minutes) significantly increased 6-minute walk test scores throughout hospitalization but had no significant changes in Brief Fatigue Inventory and Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale scores. Fatigue and QOL decreased over hospitalization but improved by discharge. Subjects who demonstrated higher participation averaged fewer hospital days (R = 1.65; P = .005). This study is unique in examining the impact of an incentive-based mobility program, participation in which may decrease length of hospital stay for HSCT patients. Randomized trials are needed to further validate these findings and assess additional variables that can influence outcomes. An incentive-based mobility program during hospitalization for HSCT has the potential to minimize fatigue and stabilize, if not improve, QOL.

Quality of life associated with acute and chronic graft-versus-host disease

Acute and chronic graft-versus-host diseases (GVHD) are associated with increased morbidity and mortality after hematopoietic stem cell transplantation (HCT). We prospectively measured the quality of life (QOL) of patients undergoing allogeneic transplantation. Ninety-six subjects completed self-assessment surveys before HCT, and at 6 and/or 12 months post-HCT that included the Medical Outcomes Study Short Form 12 (SF12) and the Functional Assessment of Cancer Therapy-Bone Marrow Transplant scale. Eighty-three percent of survivors responded at 6 and 12 months. Physical and mental functioning assessed by the SF12 was not associated with either acute or chronic GVHD. In contrast, the trial outcome index (TOI) of the Functional Assessment of Cancer Therapy-Bone Marrow Transplant was sensitive to occurrence of either acute or chronic GVHD. GVHD is a major determinant of the long-term QOL of survivors. The adverse effects of acute GVHD are detectable with the TOI at 6 months post transplantation after which development of chronic GVHD is the most strongly correlated with worse QOL.

Quality of life in adults following bone marrow transplantation during childhood.

Quality of life (QOL) was assessed in 22 young adults, 14 years - on average- after having received bone marrow transplantation (BMT) during childhood at the Leiden University Medical Center. All were disease-free and >16 years when interviewed. The sickness impact profile and the Medical Outcome Study 36-item Short Form Health Survey were used as generic questionnaires in the assessment of QOL. The Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale (FACT-BMT) was used as a disease-specific measure of QOL. Coping was assessed by means of the Utrecht coping list. BMT-related variables were obtained from medical files. Of the generic QOL measures, most results fell within the normal range of functioning, although some illness-related impairment was reported on subscales for general and work-related functioning. Compared to a reference sample of patients who had received BMT as adults, patients involved in this study scored significantly higher on the 'emotional well-being' subscale of the FACT-BMT, indicating significantly better emotional functioning. The age at BMT and total body irradiation (TBI) were not related to patients' QOL. We can conclude that at long term, having received BMT during childhood does not negatively affect the QOL of patients. Bone Marrow Transplantation (2004) 33, 329-336. doi:10.1038/sj.bmt.1704345 Published online 1 December 2003

Reduced-intensity conditioning for unrelated donor hematopoietic stem cell transplantation as treatment for myeloid malignancies in patients older than 55 years

AbstractHematopoietic stem cell transplantation from unrelated donors is an effective treatment for myeloid malignancies, but its use is usually restricted to young patients without comorbidities. The development of reduced-intensity preparative regimens has allowed the extension of this form of treatment to older and medically infirm patients. We assessed the outcomes of patients older than 54 years who received unrelated donor transplants for the treatment of myeloid malignancies in our institution. There were 29 patients (median age, 59 years) with advanced acute myeloid leukemia (n = 13), myelodysplastic syndrome (n = 7), and chronic myeloid leukemia (n = 9) included. With a median follow-up of 27 months, the probability of overall and event-free survival, and nonrelapse mortality at one year were 44%, 37%, and 55%, respectively. Grades II to IV acute graft-versus-host disease (GVHD) occurred in 41% of patients and chronic GVHD developed in 63% of patients surviving more than 100 days. Of the 11 survivors, 9 were interviewed and reported good quality of life after transplantation using the Functional Assessment of Cancer Therapy–Bone Marrow Transplant Scale (FACT-BMT) questionnaire, with high scores in all dimensions. Unrelated donor transplantation is a treatment option for older patients with myeloid malignancies. The results in this cohort of patients are comparable with those reported in younger patients with similarly advanced disease.