title: Prevalence and determinants of fatigue in patients with moderate to severe chronic GvHD.
abstract: Although fatigue is common after allogeneic hematopoietic cell transplantation, little is known about fatigue in patients with chronic GvHD (cGvHD). The aim of this study was to explore factors associated with fatigue in cGvHD. Data were drawn from a sequentially recruited, cross-sectional study of adults with moderate or severe cGvHD (n=263). Respondents were classified as fatigued or not fatigued based on their response to a single item regarding loss of energy from the Lee cGvHD Symptom Scale. In univariate analysis, factors significantly associated with fatigue included performance status, number of prior cGvHD therapies, cGvHD symptom bother, self-assessed physical and mental health, nutritional status, walk velocity and self-reported physical activity. There were no significant associations between fatigue and disease-related cGvHD variables. Multivariable logistic regression demonstrated that being less active and having pulmonary and/or muscle/joint symptoms were independently associated with fatigue. In conclusion, clinically significant fatigue was prevalent in more than one-third of subjects with cGvHD, and was disabling. Absence of association with measures of cGvHD severity underscores the need to elucidate the pathogenesis of fatigue and its relationship with inflammatory activity. Pulmonary and muscle/joint symptoms and physical inactivity represent potential targets for intervention in clinical studies.
authors.affiliation: Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Im
authors.affiliation: Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Rockville, MD, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Mitchell
authors.affiliation: Biostatistics and Data Management Section, Office of the Clinical Director, National Cancer Institute, NIH, Bethesda, MD, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Steinberg
authors.affiliation: Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
authors.forename: L
authors.initials: L
authors.lastname: Curtis
authors.affiliation: Pain and Palliative Care, Clinical Center, NIH, Bethesda, MD, USA.
authors.forename: A
authors.initials: A
authors.lastname: Berger
authors.affiliation: Pediatric Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
authors.forename: K
authors.initials: K
authors.lastname: Baird
authors.affiliation: Oncology/Hematology, Hospital Hietzing, Vienna, Austria.
authors.forename: Z
authors.initials: Z
authors.lastname: Kuzmina
authors.affiliation: Rehabilitation Medicine Department, NIH, Bethesda, MD, USA.
authors.forename: G
authors.initials: G
authors.lastname: Joe
authors.affiliation: Rehabilitation Medicine Department, NIH, Bethesda, MD, USA.
authors.forename: L E
authors.initials: LE
authors.lastname: Comis
authors.affiliation: Division of Hematology and Medical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: M
authors.initials: M
authors.lastname: Juckett
authors.affiliation: Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
authors.forename: D
authors.initials: D
authors.lastname: Avila
authors.affiliation: Clinical Research Directorate/CMRP, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA.
authors.forename: J
authors.initials: J
authors.lastname: Baruffaldi
authors.affiliation: Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
authors.forename: L
authors.initials: L
authors.lastname: Masuch
authors.affiliation: Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
authors.forename: F
authors.identifier: http://orcid.org/0000-0001-7919-0211
authors.initials: F
authors.lastname: Pirsl
authors.affiliation: Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
authors.forename: S Z
authors.initials: SZ
authors.lastname: Pavletic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018771:Arthralgia; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D015444:Exercise; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006086:Graft vs Host Disease / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D063806:Myalgia; D015995:Prevalence; D012044:Regression Analysis; D055815:Young Adult
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