No significant association between depression or antidepressant use and overall survival (OS) was observed for patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT), according to the results of a retrospective study published in Bone Marrow Transplantation.
Higher rates of clinically significant depression have been observed for HSCT recipients compared with the general US population. Although the highest rates of depression for those undergoing HSCT have been reported in the week following this procedure, post-HSCT rates of depression have been shown to remain persistently elevated in this patient population relative to the US population control group.
While earlier studies have shown an association between depression and diminished quality of life (QOL) in the setting of HSCT, conflicting evidence regarding whether or not HSCT has a detrimental effect on OS may be related to a failure to take into account antidepressant use in those studies.
In this study, demographic and clinical data were abstracted from the medical records of a cohort of 1797 adult patients with different hematologic malignancies who underwent HSCT at a single, large academic oncology center. At the time of pretransplant vital organ testing (VOT), 2 validated measures, the Patient Health Questionnaire-8 (PHQ-8) and the Medical Outcomes Study Short Form (SF-12), were used to assess depression and health-related QOL, respectively, in this patient group. In addition, antidepressant use was assessed between VOT and 3 weeks following HSCT.
Hematologic malignancies diagnosed in this patient cohort included acute myeloid leukemia (AML; 22%), multiple myeloma/amyloidosis (40%), myeloproliferative neoplasm (MPN)/myelodysplasia (10%), lymphoma (27%), other (1%).
Of the 703 patients undergoing allogeneic transplantation, 54%, 26%, 15%, 3%, and 2% had a diagnosis of AML, MPN/myelodysplasia, lymphoma, multiple myeloma/amyloidosis, and other, respectively. Regarding the 1094 patients treated with autologous transplantation, nearly two-thirds had multiple myeloma/amyloidosis and approximately one-third had lymphoma.
Separate analyses were performed for those undergoing allogeneic and autologous HSCT. Patients undergoing these procedures were classified as belonging to 1 of 4 groups: 1) treated depression, defined as not depressed/taking antidepressants; 2) undertreated depression, defined as depressed/taking antidepressants; 3) untreated depression, defined as depressed/not taking antidepressants; and 4) control, defined as not depressed/not taking antidepressants.
The percentages of patients in the allogeneic HSCT subgroup classified as belonging to groups 1 through 4 were 21%, 7%, 7%, and 65%, respectively, whereas 18%, 7%, 8%, and 67% in the autologous HSCT subgroup were classified into the respective groups.
On multivariable analyses controlling for Karnofsky performance status, regimen intensity, and time from diagnosis to HSCT, depression/antidepressant use was shown to be independently associated with physical functioning in both those undergoing allogeneic and autologous HSCT (P <.05). In both transplantation subgroups, those with treated depression had better physical functioning than those with undertreated or untreated depression, but worse physical functioning compared with the control group.
However, multivariable analyses taking into account European Bone Marrow Transplant (EBMT) risk score did not show a significant association between depression/antidepressant use and OS for those undergoing either allogeneic or autologous HSCT.
Limitations of this study included the absence of data on the indication for antidepressant use (eg, depression, pain), as well as any psychosocial care received. In addition, patients were not evaluated for depression during the peritransplant period.
The study authors noted that these results “lend support for integrated psychosocial care in the allogeneic and autologous setting.”
Barata A, Gonzalez BD, Zhou JM, et al. Associations among depression, antidepressants, survival and quality of life in hematopoietic cell transplant recipients [published online May 12, 2020]. Bone Marrow Transplant. doi: 10.1038/s41409-020-0937-y