title: Impact of pre-transplant depression on outcomes of allogeneic and autologous hematopoietic stem cell transplantation.
abstract: To evaluate the impact of depression before autologous and allogeneic hematopoietic cell transplantation (HCT) on clinical outcomes post-transplantation.
  
  
  
  We analyzed data from the Center for International Blood and Marrow Transplant Research to compare outcomes after autologous (n = 3786) or allogeneic (n = 7433) HCT for adult patients with hematologic malignancies with an existing diagnosis of pre-HCT depression requiring treatment versus those without pre-HCT depression. Using Cox regression models, we compared overall survival (OS) between patients with or without depression. We compared the number of days alive and out of the hospital in the first 100 days post-HCT using Poisson models. We also compared the incidence of grade 2-4 acute and chronic graft-versus-host disease (GVHD) in allogeneic HCT.
  
  
  
  The study included 1116 (15%) patients with pre-transplant depression and 6317 (85%) without depression who underwent allogeneic HCT between 2008 and 2012. Pre-transplant depression was associated with lower OS (hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.04-1.23; P = 0.004) and a higher incidence of grade 2-4 acute GVHD (HR, 1.25; 95% CI, 1.14-1.37; P < 0.0001), but similar incidence of chronic GVHD. Pre-transplant depression was associated with fewer days-alive-and-out-of-the hospital (means ratio [MR] = 0.97; 95% CI, 0.95-0.99; P = 0.004). There were 512 (13.5%) patients with Pre-transplant depression and 3274 (86.5%) without depression who underwent autologous HCT. Pre-transplant depression in autologous HCT was not associated with OS (HR, 1.15; 95% CI, 0.98-1.34; P = 0.096) but was associated with fewer days alive and out of the hospital (MR, 0.98; 95% CI, 0.97-0.99; P = 0.002).
  
  
  
  Pre-transplant depression was associated with lower OS and higher risk of acute GVHD among allogeneic HCT recipients and fewer days alive and out of the hospital during the first 100 days after autologous and allogeneic HCT. Patients with pre-transplant depression represent a population that is at risk for post-transplant complications. Cancer 2017;123:1828-1838. © 2017 American Cancer Society.
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
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authors.lastname: El-Jawahri
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Yi-Bin
authors.initials: YB
authors.lastname: Chen
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.|Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Ruta
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authors.lastname: Brazauskas
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
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authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Stephanie J
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authors.lastname: Lee
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Jennifer M
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authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
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authors.forename: William A
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authors.affiliation: The Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
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authors.affiliation: King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia.
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authors.lastname: Aljurf
authors.affiliation: Royal Melbourne Hospital, Victoria, Australia.
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authors.lastname: Szer
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Beattie
authors.affiliation: National Heart, Lung, and Blood Institute, Bethesda, Maryland.
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authors.lastname: Battiwalla
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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authors.affiliation: Hospital Infantil Universitario Nino Jesus, Madrid, Spain.
authors.forename: Miguel-Angel
authors.initials: MA
authors.lastname: Diaz
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Anita
authors.initials: A
authors.lastname: D'Souza
authors.affiliation: University of Texas Health Science Center San Antonio, San Antonio, Texas.
authors.forename: Cesar O
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authors.lastname: Freytes
authors.affiliation: Oregon Health and Science University, Portland, Oregon.
authors.forename: James
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authors.forename: Usama
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authors.lastname: Gergis
authors.affiliation: Brandeis University, Waltham, Massachusetts.
authors.forename: Shahrukh K
authors.initials: SK
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authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Ann
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authors.lastname: Jakubowski
authors.affiliation: Baylor College of Medicine, Houston, Texas.
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authors.lastname: Kamble
authors.affiliation: University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Tamila
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authors.lastname: Kindwall-Keller
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authors.affiliation: Tisch Cancer Institute, New York, New York.
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authors.affiliation: University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
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authors.lastname: Marks
authors.affiliation: Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
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authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Bipin N
authors.initials: BN
authors.lastname: Savani
authors.affiliation: Karolinska Institute, Stockholm, Sweden.|Uppsala University, Uppsala, Sweden.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Olsson
authors.affiliation: Duke University, Durham, North Carolina.
authors.forename: David
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authors.lastname: Rizzieri
authors.affiliation: Mount Sinai Hospital, New York, New York.
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authors.affiliation: Northside Hospital, Atlanta, Georgia.
authors.forename: Dawn
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authors.lastname: Speckhart
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: David
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authors.lastname: Szwajcer
authors.affiliation: University Hospital of Leuven, Leuven, Belgium.
authors.forename: Helene
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authors.lastname: Schoemans
authors.affiliation: East Hospital, Kashiwa, Chiba, Japan.
authors.forename: Sachiko
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authors.lastname: Seo
authors.affiliation: University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: Celalettin
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authors.lastname: Ustun
authors.affiliation: Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.|Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Atsuta
authors.affiliation: The Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
authors.forename: Jignesh
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authors.affiliation: Hospital de Clinicas, Federal University of Parana, Curitiba, Brazil.
authors.forename: Carmem
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authors.lastname: Sales-Bonfim
authors.affiliation: Mayo Clinic, Phoenix, Arizona.
authors.forename: Nandita
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authors.lastname: Khera
authors.affiliation: Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Theresa
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authors.lastname: Hahn
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Wael
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authors.lastname: Saber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000523:psychology*; D003866:Depressive Disorder / Q000523:psychology*; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007938:Leukemia / Q000523:psychology / Q000628:therapy*; D008223:Lymphoma / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000523:psychology / Q000628:therapy*; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000523:psychology / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: GVHD; autologous HCT; depression; pre-HCT depression; transplant outcomes