Pretransplant Depression Associated With Worse Overall Survival

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Depression can affect cancer survival.
Depression can affect cancer survival.

Pretransplant depression was associated with worse overall survival and a higher risk for developing acute graft-versus-host disease (GVHD) among recipients of allogeneic hematopoietic cell transplantation (HCT), according to a study published in the journal Cancer.1

To assess the impact of depression prior to autologous and allogeneic HCT on postransplantation clinical outcomes, researchers analyzed data from 11,219 adult patients with hematologic malignancies, including 3786 who underwent autologous HCT and 7433 allogeneic HCT recipients.

Among those who underwent allogeneic HCT between 2008 and 2012, results showed that 1116 (15%) patients had pretransplant depression and 6317 (85%) did not have depression.

Results showed that pretransplant depression was significantly associated with a 13% higher risk of death (hazard ratio [HR], 1.13; 95% CI, 1.04-1.23; P =.004) and a 25% higher risk for developing grade 2 to 4 acute GVHD (HR, 1.25; 95% CI, 1.14-1.37; P <.0001); however, the incidence of chronic GVHD was similar between patients with pretransplant depression and those without depression.

Investigators also found that pretransplant depression was associated with fewer days alive and out of the hospital during the first 100 days post-HCT (P =.004).

Among autologous HCT recipients, there were 512 (13.5%) patients with pretransplant depression and 3274 (86.5%) without depression.

The study demonstrated no significant association between pretransplant depression and overall survival in this population (HR, 1.15; 95% CI, 0.98-1.34; P =.096), but it was associated with fewer days alive and out of the hospital (P =.002).

The findings ultimately suggest that patients with pretransplant depression are at a higher risk for posttransplant complications. Future studies should evaluate whether supportive care in patients with pretransplant depression improves oncologic outcomes.

Reference

1. El-Jawahri A, Chen YB, Brazauskas R, et al. Impact of pre-transplant depression on outcomes of allogeneic and autologous hematopoietic stem cell transplantation. 2017 Jan 19. doi: 10.1002/cncr.30546. [Epub ahead of print]

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