Depression Prior to HCT is Prognostic of Lower Survival, Higher Acute GVHD

Pre-transplant depression requiring treatment significantly affected post-allogenic hematopoietic cell transplant (HCT) outcomes, including lower overall survival (OS) and higher risk of acute graft-versus-host disease (GVHD). This large-scale, retrospective study analyzed 11,219 autologous and allogeneic transplant outcomes reported to CIBMTR® (Center for International Blood and Marrow Transplant Research®) between 2008 and 2012.

Among the 1,116 (15%) patients with pre-transplant depression and 6,317 (85%) without depression who underwent allogeneic HCT, pre-transplant depression was significantly 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 II-IV acute GVHD (HR, 1.25; 95% CI, 1.14-1.37; p<0.0001). Pre-transplant depression was associated with fewer days alive and out of hospital (means ratio [MR]=0.97; 95% CI, 0.95-0.99; p=0.004). Cumulative incidence of chronic GVHD was comparable in both groups.

Among the 512 patients with pre-transplant depression (13.5%) and 3,274 without depression (86.5%) who underwent autologous HCT, pre-transplant depression 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 hospital (MR, 0.98; 95% CI, 0.97-0.99; p=0.002).

The researchers concluded that patients with pre-transplant depression represent a population at risk for post-transplant complications, and that referring physicians may have a role in assessing depression and potentially treating transplant patients prior to HCT to improve outcomes.

El-Jawahri A, et al. Cancer

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