Depression, cigarette smoking, and hematopoietic stem cell transplantation outcome.
BACKGROUND
The relationships between psychological and behavioral variables and patient outcomes after hematopoietic stem cell transplantation (HSCT) are not known definitively but have great potential importance, since this lifesaving procedure is used increasingly to treat a variety of malignancies. The objective of this study was to evaluate psychosocial predictors of long-term survival and disease recurrence after patients underwent allogeneic HSCT for chronic myelogenous leukemia (CML).


METHODS
In this prospective cohort study, 114 adults were admitted for allogeneic HSCT to the Brigham and Women's Hospital between July, 1997 and January, 2002. The median follow-up was 882 days, and serial measures were taken for mood and substance use 6 months and 12 months posttransplantation.


RESULTS
With a 93% participation rate by all potentially eligible patients and with < 3% of patients loss to follow-up, univariate predictors of long-term survival and recurrence were identified. Cox proportional hazards regression models for survival and recurrence were developed. Depressive symptoms, as measured by the most recent Beck Depression Inventory (BDI), increased the risk of death by 7% for each point increase in the BDI score (P = 0.006). Fourteen of 17 patients who developed recurrent disease were cigarette smokers with an average of 22.3 pack-years. For each pack-year of cigarette smoking, the risk of recurrence increased by 1.7% (P = 0.01).


CONCLUSIONS
This study assessed the role of psychosocial variables prospectively among a clinically homogeneous but representative cohort of patients who underwent allogeneic HSCT. Although additional confirmatory studies are pending, it appears that depressive symptoms posttransplantation and cigarette smoking prior to transplantation affect outcomes adversely and may represent opportunities to improve the morbidity and mortality associated with HSCT for patients with CML.
Chang
Grace
G
Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. gchang@partners.org
Orav
E John
EJ
McNamara
Tay
T
Tong
Mei-Yee
MY
Antin
Joseph H
JH
D000328:Adult; D003863:Depression; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012907:Smoking; D016019:Survival Analysis; D016896:Treatment Outcome