Resolved versus active chronic graft-versus-host disease: Impact on post-transplant quality of life
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2019
The aim of this study was to determine if impaired quality of life (QOL) persisted among patients who experienced resolved chronic graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation (allo-HCT). Eligible participants were patients who were relapse-free for 3 years after allo-HCT who were aged ≥16 years at transplant and aged ≥20 years without relapse at survey. The SF-36, FACT-BMT, and VAS were administered to assess QOL. Physicians evaluated the current status of chronic GVHD at survey by NIH criteria, and pre-transplant characteristics and history of GVHD were extracted from the national transplant registry database. Patients without currently active GVHD but with a history of chronic GVHD were categorized as having "resolved GVHD." Of 1250 patients informed of the study, 1216 provided consent, and 1130 patients were included in the final analysis. A total of 745 patients (66%) had currently active chronic GVHD, 149 (13%) had resolved chronic GVHD, and 236 (21%) never had chronic GVHD after allo-HCT. Multivariable analyses showed that compared to patients with resolved or no chronic GVHD, those with active chronic GVHD reported significantly poorer QOL. QOL scores were similar between patients with resolved and no chronic GVHD. Larger differences were observed in SF-36 physical component and VAS scores between the two groups in patients aged ≥50 years, however these were not statistically significant. In conclusion, only currently active chronic GVHD has a significant impact on physical, mental, and social QOL in allo-HCT survivors, while past chronic GVHD does not impair QOL if it is resolved.