Quality of life before autologous stem cells transplantation as prognostic factor in patients with malignant lymphomas

Currently high-doses chemotherapy (HD-PCT) + autologous hematopoietic stem cells transplantation (auto-HSCT) is the treatment of
choice in patients with recurrent and progressive lymphomas. Most of quality of life (QoL) studies in lymphomas patients received HSCT limited on parameters dynamics assessment in the early and late post-transplant period. Aim of this study was to evaluate the QoL parameters and their prognostic significance in lymphoma patients before transplantation. 124 patients with lymphomas (non-Hodgkin lymphomas – 45 patients, Hodgkin's lymphoma – 79 patients) who received HD-PCT + auto-HSCT were included in the study: men – 42.7 % (n = 53), women – 57.3 % (n = 71), median age – 34 years (19–65 years). Patients’ heterogeneity before transplantation regarding quality of life has been revealed. Almost 1/3 of patients showed a significant reduction in the integral index of QoL. Insignificant differences between patients with chemosensitivity and chemoresistant lymphomas regarding QoL before HD-PCT + auto-HSCT were shown. We also analyzed the outcomes of studied patients received HD-PCT + auto-HSCT. With a median follow-up of 18 months, overall survival after transplantation was 72 % (95 % CI 56–84); event-free survival – 64 % (95 % CI 53,3–73,2).
Overall and event-free survivals were significantly higher in patients with chemosensitive lymphoma compared with chemoresistance tumor. Differences in the survival rates between patients with no or negligible decrease of QoL integral index and with significant reduction of it also were found. Revealed differences in overall and event-free survival between the groups allowed the first group considered as patients with a favorable prognosis, and the second group – as patients with poor prognosis regarding the transplantation outcome.

1. Hasenclever D., Diehl V. A prognostic score for advanced Hodgkin’s disease. International Prognostic Factors Project on Advanced Hodgkin’s Disease. New Engl J Med 1998;339:1506–14.

2. A predictive model for aggressive non-Hodgkin’s lymphoma. The International Non-Hodgkin’s Lymphoma Prognostic Factors Project. New Engl J Med 1993;329(14):987–94.

3. Jerkeman M., Kaasa S., Kvaloy S. et al. Health-related quality of life, as assessed by the EORTC QLQ-C30 (v 1.0), in patients with aggressive lymphomas treated with CHOP or MACOP-B in a multicentre randomized trial by the Nordic Lymphoma Group. Ann Oncol 1998;9(4):5190.

4. Jung H.A., Park S., Cho J.H. et al. Prognostic relevance of pretreatment quality of life in diffuse large B-cell lymphoma patients treated with rituximab-CHOP: results from a prospective cohort study. Ann Hematol 2012;91(11):1747–56.

5. Hays R.D., Sherbourne C.D., Mazel R.M. User’s Manual for Medical Outcomes Study (MOS) Core measures of health-related quality of life. RAND Corporation, MR-162-RC (available at www.rand.org).

6. Новик А.А., Ионова Т.И. Интегральный показатель качества жизни – новая категория в концепции исследования качества жизни. Вестн Межнационал центра исследования качества жизни 2006;7–8:7–8.

7. Шевченко Ю.Л., Новик А.А., Ионова Т.И. и др. Метод интегральных профилей в изучении качества жизни больных ревматоидным артритом. Вестн Межнационал центра исследования качества жизни 2004;3–4:5–10.

8. Осипова Н.Э., Федоренко Д.А., Киштович А.В и др. Показатели качества жизни, боль и слабость у больных неходжкинскими лимфомами: взаимосвязь с международным прогностическим индексом. Вестн Межнационал центра исследования качества жизни 2005;5–6:58–76.

9. Новицкий А.В. Клинико-иммунные особенности и стратификация риска у больных злокачественными лимфомами. Автореф. дис. … д-ра мед. наук. СПб., 2011.

10. Новик А.А., Ионова Т.И. Руководство по исследованию качества жизни в медицине. Под ред. академика РАМН Ю.Л. Шевченко. М.: РАЕН, 2012.

11. Andrykowski M.A., Bruehl S., Brady M.J. Physical and psychosocial status of adults oneyear after bone marrow transplantation: A prospective study. Bone Marrow Transplant 1995;15:837–44.

12. Andrykowski M.A., Bishop M.M., Hahn E.A. et al. Long-term health-related quality of life, growth and spiritual well-being after hematopoietic stem-cell transplantation. J Clin Oncol 2005;23(3):599–608.

13. Molassiotis A., Van der Akker O., Milligan D. et al. Quality of life in long-term survivors of marrow transplantation: Comparison with a matched group receiving maintenance chemotherapy. Bone Marrow Transplant 1996;17:249–58.

14. Neitzert C.S., Ritvo P., Dancey J. et al. The psychosocial impact of bone marrow transplantation: A review of the literature. Bone Marrow Transplant 1998;22:409–22.

15. Wingard J.R. Quality of life following bone marrow transplantation. Curr Opin Oncol 1998;10:108–11.

16. Chao N.J., Tierney D.K., Bloom J.R. et al. Dynamic assessment of quality of life after autologous bone marrow transplantation. Blood 1992;80:825–30.

17. Cohen M.Z., Mendoza T., Neumann J. et al. Longitudinal assessment of symptoms and quality of life: Differences by ablative and nonablative blood and marrow transplantation. J Clin Oncol 2004;22(15):6630.

18. Hjermstad M.J., Kaasa S. Quality of life in adult cancer patients treated with bone marrow transplantation – a review of the literature. Eur J Cancer 1995;31A:163–73.

19. McQuellon R.P., Russel G.B., Rambo T.D. et al. Quality of life and psychological distress of bone marrow transplant recipients: the “time trajectory” to recovery over the first year. Bone Marrow Transplant 1998;21:477–86.

20. Wettergren L., Sprangers M., Bjorkholm M. et al. Quality of life before and one year following stem cell transplantation using an individualized and a standartdized instrument. Psychooncology 2008;17(4):338–46.