Patients with acute myeloid leukemia report ongoing symptoms, impacts after transplant
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Individuals with acute myeloid leukemia in remission after hematopoietic stem cell transplantation reported ongoing symptoms and impacts in the post-transplant period, according to research presented at ASH Annual Meeting and Exposition.
However, some of these effects appeared to attenuate with time, researchers noted.
“We certainly expected to identify some significant symptoms and disease impacts in these transplant survivors, especially with the participants all being less than 1 year out from transplant,” Thomas W. LeBlanc, MD, MA, MHS, associate professor of medicine and population health sciences at Duke University and founding director of the Duke Cancer Patient Experience Program, told Healio. “Knowing what we know about these persistent symptoms and impacts among AML survivors after HSCT, we should further study and develop better ways to support patients through the transplant survivorship period.”
Patient characteristics
To better understand the patient experience after transplant for AML, LeBlanc and researchers at Duke and Northwestern University’s Feinberg School of Medicine interviewed 20 patients (median age 59.5 years; 55% female) diagnosed with AML and in remission at 90 or more days after transplant but less than 1 year after the transplant date. They estimated the number of patients interviewed based on the expected number needed to achieve concept saturation (the point at which they noted no new symptoms or concepts in the interviews).
The researchers used an interview guide that included a list of symptoms and impacts identified in a previous study of patients with relapsed/refractory AML. They adapted the list for the post-transplant population based on clinician discussions and results of a literature review. The one-on-one interviews included a series of open-ended questions about patient disease experiences, with an emphasis on the most bothersome or notable post-transplant impacts.
Patients rated symptoms and impacts on a scale of 0 to 10, with 10 being the most severe or bothersome. Researcher defined salient symptoms as those at least 50% of respondents reported as being pertinent and rated most significant.
The researchers identified 17 patients as having FLT3 mutations. They achieved symptom saturation in the first wave of interviews (42 total concepts; 13 new symptoms identified) and impact saturation in the second wave (28 total concepts; 12 new impacts identified). In their interviews, patients discussed both negative and positive impacts.
Post-transplant symptoms, impacts
The researchers identified the following salient symptoms: fatigue, weakness, nausea, pain and diarrhea. The disturbance ratings for the most relevant symptoms showed a decrease between the peak rating and the current rating, indicating the symptoms were less troublesome over time.
“We aren’t able to determine the cause of these symptoms definitively, but the expectation is that they are likely related to some aspect of transplantation and/or ongoing medications for post-transplant issues,” LeBlanc said.
Salient impacts included one positive impact (improvement in life outlook) and six negative impacts (fear, reduced ability to maintain usual roles, anxiety, loss of appetite, decreased ability to function and change in appearance).
“Thus, for some, going through the transplant and surviving it — and possibly being cured of their leukemia as a result — gave them a more positive look on life and the future,” LeBlanc told Healio.
In terms of their disturbance to patients, the impacts remained more stable over time than symptoms.
“We don’t know for sure whether these issues will continue to improve, but I expect there is probably a mixture of some persistent symptoms while others indeed continue to improve with time,” he said.
LeBlanc said these findings may justify some changes in the way post-transplant care is handled for patients with AML. Specifically, he said the inclusion of palliative care services may be useful.
“One promising approach is to better integrate specialist palliative care services into the transplantation process, even into survivorship,” he said. “Several studies show that palliative care integration can improve symptoms, quality of life, anxiety, depression and other issues among patients with AML receiving high-dose chemotherapy, and also those hospitalized for HSCT, but this has not yet been studied in the post-transplant survivorship period.”
For more information:
Thomas W. LeBlanc, MD, MA, MHS, can be reached at Duke Cancer Institute, 2424 Erwin Road, Suite 602, Durham NC 27705; email: thomas.leblanc@duke.edu.
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Cella D, et al. Presented at: ASH Annual Meeting and Exposition, Dec. 11-14, 2021; Atlanta.
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