The effect of pre-transplant distress on immune reconstitution among adult autologous hematopoietic cell transplantation patients.
Myeloablative hematopoietic cell transplantation (HCT) is a common treatment for hematological malignancy. Delayed immune reconstitution following HCT is a major impediment to recovery with patients being most vulnerable during the first month after transplant. HCT is a highly stressful process. Because psychological distress has been associated with down regulation of immune function we examined the effect of pre-transplant distress on white blood cell (WBC) count among 70 adult autologous HCT patients during the first 3 weeks after transplant. The participants were on average 38 years old; 93% Caucasian, non-Hispanic and 55% male. Pre-transplant distress was measured 2-14 days before admission using the Cancer and Treatment Distress (CTXD) scale, and the Symptom Checklist-90-R (SCL-90-R) anxiety and depression subscales. WBC count was measured during initial immune recovery on days 5 through 22 post-transplant. Linear mixed model regression analyses controlling for gender and treatment-related variables revealed a significant effect of the mean pre-transplant SCL Anxiety-Depression score on WBC recovery. We found no significant effect of pre-transplant CTXD on WBC recovery. In general, higher levels of pre-treatment anxiety and depression were associated with slower WBC recovery. Psychological modulation of WBC recovery during HCT suggests a unique mechanism by which psychological distress can exert influence over the immune system. Given that WBC recovery is essential to survival for HCT patients, these data provide a rationale for treating anxiety and depression in HCT patients.
Public Health Sciences, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, WA 98109, USA. bmcgrego@fhcrc.org
Bonnie A
BA
McGregor
Karen L
KL
Syrjala
Emily D
ED
Dolan
Shelby L
SL
Langer
Mary
M
Redman
D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000276:immunology / Q000523:psychology; D003863:Depression / Q000276:immunology / Q000523:psychology; D005260:Female; D019337:Hematologic Neoplasms / Q000276:immunology / Q000523:psychology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000523:psychology*; D006801:Humans; D007958:Leukocyte Count; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D012737:Sex Factors; D013315:Stress, Psychological / Q000276:immunology* / Q000523:psychology; D016896:Treatment Outcome