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Recovery and Long-term Function After Hematopoietic Cell Transplantation for Leukemia or Lymphoma
Karen L. Syrjala, PhD;
Shelby L. Langer, PhD;
Janet R. Abrams, PsyD;
Barry Storer, PhD;
Jean E. Sanders, MD;
Mary E. D. Flowers, MD;
Paul J. Martin, MD
JAMA. 2004;291:2335-2343.
Context Hematopoietic cell transplantation (HCT) is an effective and widely used treatment for hematologic malignancies. The rate and predictors of physical and emotional recovery after HCT have not been adequately defined in prospective long-term studies.
Objective To examine the course of recovery and return to work after HCT.
Design, Setting, and Patients Prospective, longitudinal cohort study at a US academic center specializing in HCT. Function was assessed from pretransplantation to 5-year follow-up for 319 adults who had myeloablative HCT for treatment of leukemia or lymphoma and spoke English. Of the 99 long-term survivors who had no recurrent malignancy, 94 completed 5-year follow-up.
Main Outcome Measures Physical limitations, return to work, depression, and distress related to treatment or disease were evaluated before transplantation, at 90 days, and at 1, 3, and 5 years after HCT.
Results Physical recovery occurred earlier than psychological or work recovery. Only 21 patients (19%) recovered on all outcomes at 1 year. The proportion without major limitations increased to 63% (n = 57) by 5 years. Among survivors without recurrent malignancy, 84% (n = 74) returned to full-time work by 5 years. Patients with slower physical recovery had higher medical risk and were more depressed before HCT (P .001). Patients with chronic graft-vs-host disease (P = .01), with less social support before HCT (P = .001), and women (P<.001) were more depressed after transplantation. Transplant-related distress was slower to recover for allogeneic transplant recipients and those with less social support before HCT (P.01). Patients who had more experience with cancer treatment before beginning HCT had more rapid recovery from depression (P = .04) and treatment-related distress (P = .009).
Conclusions Full recovery after HCT is a 3- to 5-year process. Recovery might be accelerated by more effective interventions to increase work-related capabilities, improve social support, and manage depression.
Author Affiliations: Clinical Research Division, Fred Hutchinson Cancer Research Center (Drs Syrjala, Langer, Abrams, Storer, Sanders, Flowers, and Martin) and the Departments of Psychiatry and Behavioral Sciences (Drs Syrjala, Langer, and Abrams), Pediatrics (Dr Sanders), and Medicine (Drs Flowers and Martin), University of Washington School of Medicine, Seattle..
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