title: Prognostic significance of pre-transplant quality of life in allogeneic hematopoietic cell transplantation recipients.
abstract: Quality of life (QOL) is an important outcome for hematopoietic cell transplantation (HCT) recipients. Whether pre-HCT QOL adds prognostic information to patient and disease related risk factors has not been well described. We investigated the association of pre-HCT QOL with relapse, non-relapse mortality (NRM), and overall mortality after allogeneic HCT. From 2003 to 2012, the Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale instrument was administered before transplantation to 409 first allogeneic HCT recipients. We examined the association of the three outcomes with (1) individual QOL domains, (2) trial outcome index (TOI) and (3) total score. In multivariable models with individual domains, functional well-being (hazard ratio (HR) 0.95, P=0.025) and additional concerns (HR 1.39, P=0.002) were associated with reduced risk of relapse, no domain was associated with NRM, and better physical well-being was associated with reduced risk of overall mortality (HR 0.97, P=0.04). TOI was not associated with relapse or NRM but was associated with reduced risk of overall mortality (HR 0.93, P=0.05). Total score was not associated with any of the three outcomes. HCT-comorbidity index score was prognostic for greater risk of relapse and mortality but not NRM. QOL assessments, particularly physical functioning and functional well-being, may provide independent prognostic information beyond standard clinical measures in allogeneic HCT recipients.
authors.affiliation: Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: B K
authors.initials: BK
authors.lastname: Hamilton
authors.affiliation: Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Law
authors.affiliation: Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: L
authors.initials: L
authors.lastname: Rybicki
authors.affiliation: Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: D
authors.initials: D
authors.lastname: Abounader
authors.affiliation: Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: J
authors.initials: J
authors.lastname: Dabney
authors.affiliation: Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: R
authors.initials: R
authors.lastname: Dean
authors.affiliation: Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: H K
authors.initials: HK
authors.lastname: Duong
authors.affiliation: Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: A T
authors.initials: AT
authors.lastname: Gerds
authors.affiliation: Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: R
authors.initials: R
authors.lastname: Hanna
authors.affiliation: Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: B T
authors.initials: BT
authors.lastname: Hill
authors.affiliation: Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: D
authors.initials: D
authors.lastname: Jagadeesh
authors.affiliation: Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Kalaycio
authors.affiliation: Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: C
authors.initials: C
authors.lastname: Lawrence
authors.affiliation: Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: L
authors.initials: L
authors.lastname: McLellan
authors.affiliation: Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: B
authors.initials: B
authors.lastname: Pohlman
authors.affiliation: Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Sobecks
authors.affiliation: Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Bolwell
authors.affiliation: Taussig Cancer Institute, Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: N S
authors.initials: NS
authors.lastname: Majhail
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D018572:Disease-Free Survival; D005260:Female; D019337:Hematologic Neoplasms / Q000401:mortality* / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D015996:Survival Rate