QOL poor among patients with moderate, severe chronic GVHD

52nd ASH Annual Meeting

ORLANDO — According to data from a multicenter, observational study, patients with chronic graft-versus host disease have impaired quality of life compared with the normal population or those with other immunity disorders. In addition, the NIH consensus criteria for global scoring of chronic GVHD are independently related to patient-reported QOL.

“We understand that QOL is one of allogeneic hematopoietic stem cell transplant survivors’ central concerns,” Joseph Pidala, MD, MS, assistant professor, department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, said during his presentation. “However, the relationship between quality of life and the proposed NIH chronic graft-versus-host disease global severity is not known.”

Pidala and colleagues from the Chronic GVHD Consortium, aimed to describe the relationship between NIH chronic GVHD (cGVHD) global severity and QOL; compare the QOL of cohort members to US population normative data and patients with other chronic health conditions; and investigate the ability of FACT-BMT and SF-36 QOL instruments to discriminate severity of chronic GVHD.

The study enrolled 298 adult patients with cGVHD a median of 12.3 months after allogeneic hematopoietic stem cell transplantation. Standardized information on cGVHD severity was recorded at enrollment and again every 3 to 6 months. Functional assessments, including a walk test and grip strength, were conducted. FACT-BMT and SF-36 were used to assess QOL.

More than half (56%) of patients had classic cGVHD and 44% had overlap cGVHD; 10% of patients had mild, 59% had moderate and 31% had severe cGVHD. The skin (63%), mouth (61%), eye (50%) and liver (50%) were the most commonly involved organs, according to Pidala.

The relationship between cGVHD and QOL was confirmed using univariable modeling; age was also significantly related to QOL. According to multivariable linear regression analysis adjusting for age at enrollment, QOL measures differed according to severity of cGVHD. Those measures relating to physical functioning were especially different: the SF-36 average Physical Component Summary (PCS) score was 5.6 points higher for mild cGVHD compared with severe disease (P<0.01) and 3.2 points higher for moderate cGVHD compared with severe disease (P=0.02), according to the researchers.

Patients with cGVHD also had lower mean scores for physical functioning, body pain, general health, vitality, social functioning and PCS on the SF-36, compared with gender- and age-matched US population normative data. According to Pidala, there were no significant differences in the domains of emotional, mental health, or Mental Component Summary (MCS).

PCS scores were similar among patients with moderate or severe cGVHD and patients with other chronic health conditions, such as systemic sclerosis, systemic lupus erythematosis, and multiple sclerosis. However, scores were worse compared with patients with conditions such as diabetes, hypertension and chronic lung disease, Pidala said.

In addition, MCS scores among patients with mild to moderate GVHD were similar to the normative population, but those with severe cGVHD had MCS scores that rivaled those of patients with depression.

There was no significant difference in the discriminative ability of either QOL scale.

“We conclude that prevention and control of chronic GVHD may improve patient-reported QOL,” Pidala said. “In future analyses we will assess the sensitivity of changes in chronic GVHD severity to change in patient-reported QOL.” – by Stacey L. Fisher

For more information:

Pidala J. #393. Presented at: 52nd ASH Annual Meeting; Dec. 4-7, 2010; Orlando, Fla.

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