Impact of pre-transplant depression on outcomes of allogeneic and autologous hematopoietic stem cell transplantation

Areej El-Jawahri; Yi Bin Chen; Ruta Brazauskas; Naya He; Stephanie J. Lee; Jennifer M. Knight; Navneet Majhail; David Buchbinder; Raquel M. Schears; Baldeep M. Wirk; William A. Wood; Ibrahim Ahmed; Mahmoud Aljurf; Jeff Szer; Sara M. Beattie; Minoo Battiwalla; Christopher Dandoy; Miguel Angel Diaz; Anita D'Souza; Cesar O. Freytes; James Gajewski; Usama Gergis; Shahrukh K. Hashmi; Ann Jakubowski; Rammurti T. Kamble; Tamila Kindwall-Keller; Hilard M. Lazarus; Adriana K. Malone; David I. Marks; Kenneth Meehan; Bipin N. Savani; Richard F. Olsson; David Rizzieri; Amir Steinberg; Dawn Speckhart; David Szwajcer; Helene Schoemans; Sachiko Seo; Celalettin Ustun; Yoshiko Atsuta; Jignesh Dalal; Carmem Sales-Bonfim; Nandita Khera; Theresa Hahn; Wael Saber

doi:10.1002/cncr.30546

Impact of pre-transplant depression on outcomes of allogeneic and autologous hematopoietic stem cell transplantation

Areej El-Jawahri, Yi Bin Chen, Ruta Brazauskas, Naya He, Stephanie J. Lee, Jennifer M. Knight, Navneet Majhail, David Buchbinder, Raquel M. Schears, Baldeep M. Wirk, William A. Wood, Ibrahim Ahmed, Mahmoud Aljurf, Jeff Szer, Sara M. Beattie, Minoo Battiwalla, Christopher Dandoy, Miguel Angel Diaz, Anita D'Souza, Cesar O. FreytesJames Gajewski, Usama Gergis, Shahrukh K. Hashmi, Ann Jakubowski, Rammurti T. Kamble, Tamila Kindwall-Keller, Hilard M. Lazarus, Adriana K. Malone, David I. Marks, Kenneth Meehan, Bipin N. Savani, Richard F. Olsson, David Rizzieri, Amir Steinberg, Dawn Speckhart, David Szwajcer, Helene Schoemans, Sachiko Seo, Celalettin Ustun, Yoshiko Atsuta, Jignesh Dalal, Carmem Sales-Bonfim, Nandita Khera, Theresa Hahn, Wael Saber

Hematology/Oncology

Research output: Contribution to journal › Article › peer-review

35 Scopus citations

Abstract

BACKGROUND: To evaluate the impact of depression before autologous and allogeneic hematopoietic cell transplantation (HCT) on clinical outcomes post-transplantation. METHODS: We analyzed data from the Center for International Blood and Marrow Transplant Research to compare outcomes after autologous (n = 3786) or allogeneic (n = 7433) HCT for adult patients with hematologic malignancies with an existing diagnosis of pre-HCT depression requiring treatment versus those without pre-HCT depression. Using Cox regression models, we compared overall survival (OS) between patients with or without depression. We compared the number of days alive and out of the hospital in the first 100 days post-HCT using Poisson models. We also compared the incidence of grade 2-4 acute and chronic graft-versus-host disease (GVHD) in allogeneic HCT. RESULTS: The study included 1116 (15%) patients with pre-transplant depression and 6317 (85%) without depression who underwent allogeneic HCT between 2008 and 2012. Pre-transplant depression was 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 2-4 acute GVHD (HR, 1.25; 95% CI, 1.14-1.37; P < 0.0001), but similar incidence of chronic GVHD. Pre-transplant depression was associated with fewer days-alive-and-out-of-the hospital (means ratio [MR] = 0.97; 95% CI, 0.95-0.99; P = 0.004). There were 512 (13.5%) patients with Pre-transplant depression and 3274 (86.5%) without depression who underwent autologous HCT. Pre-transplant depression in autologous HCT 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 the hospital (MR, 0.98; 95% CI, 0.97-0.99; P = 0.002). CONCLUSION: Pre-transplant depression was associated with lower OS and higher risk of acute GVHD among allogeneic HCT recipients and fewer days alive and out of the hospital during the first 100 days after autologous and allogeneic HCT. Patients with pre-transplant depression represent a population that is at risk for post-transplant complications. Cancer 2017;123:1828–1838.

Original language	English (US)
Pages (from-to)	1828-1838
Number of pages	11
Journal	Cancer
Volume	123
Issue number	10
DOIs	https://doi.org/10.1002/cncr.30546
State	Published - May 15 2017

Keywords

GVHD
autologous HCT
depression
pre-HCT depression
transplant outcomes

ASJC Scopus subject areas

Oncology
Cancer Research

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10.1002/cncr.30546

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El-Jawahri, A., Chen, Y. B., Brazauskas, R., He, N., Lee, S. J., Knight, J. M., Majhail, N., Buchbinder, D., Schears, R. M., Wirk, B. M., Wood, W. A., Ahmed, I., Aljurf, M., Szer, J., Beattie, S. M., Battiwalla, M., Dandoy, C., Diaz, M. A., D'Souza, A., ... Saber, W. (2017). Impact of pre-transplant depression on outcomes of allogeneic and autologous hematopoietic stem cell transplantation. Cancer, 123(10), 1828-1838. https://doi.org/10.1002/cncr.30546

El-Jawahri, A, Chen, YB, Brazauskas, R, He, N, Lee, SJ, Knight, JM, Majhail, N, Buchbinder, D, Schears, RM, Wirk, BM, Wood, WA, Ahmed, I, Aljurf, M, Szer, J, Beattie, SM, Battiwalla, M, Dandoy, C, Diaz, MA, D'Souza, A, Freytes, CO, Gajewski, J, Gergis, U, Hashmi, SK, Jakubowski, A, Kamble, RT, Kindwall-Keller, T, Lazarus, HM, Malone, AK, Marks, DI, Meehan, K, Savani, BN, Olsson, RF, Rizzieri, D, Steinberg, A, Speckhart, D, Szwajcer, D, Schoemans, H, Seo, S, Ustun, C, Atsuta, Y, Dalal, J, Sales-Bonfim, C, Khera, N, Hahn, T & Saber, W 2017, 'Impact of pre-transplant depression on outcomes of allogeneic and autologous hematopoietic stem cell transplantation', Cancer, vol. 123, no. 10, pp. 1828-1838. https://doi.org/10.1002/cncr.30546

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title = "Impact of pre-transplant depression on outcomes of allogeneic and autologous hematopoietic stem cell transplantation",

abstract = "BACKGROUND: To evaluate the impact of depression before autologous and allogeneic hematopoietic cell transplantation (HCT) on clinical outcomes post-transplantation. METHODS: We analyzed data from the Center for International Blood and Marrow Transplant Research to compare outcomes after autologous (n = 3786) or allogeneic (n = 7433) HCT for adult patients with hematologic malignancies with an existing diagnosis of pre-HCT depression requiring treatment versus those without pre-HCT depression. Using Cox regression models, we compared overall survival (OS) between patients with or without depression. We compared the number of days alive and out of the hospital in the first 100 days post-HCT using Poisson models. We also compared the incidence of grade 2-4 acute and chronic graft-versus-host disease (GVHD) in allogeneic HCT. RESULTS: The study included 1116 (15%) patients with pre-transplant depression and 6317 (85%) without depression who underwent allogeneic HCT between 2008 and 2012. Pre-transplant depression was 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 2-4 acute GVHD (HR, 1.25; 95% CI, 1.14-1.37; P < 0.0001), but similar incidence of chronic GVHD. Pre-transplant depression was associated with fewer days-alive-and-out-of-the hospital (means ratio [MR] = 0.97; 95% CI, 0.95-0.99; P = 0.004). There were 512 (13.5%) patients with Pre-transplant depression and 3274 (86.5%) without depression who underwent autologous HCT. Pre-transplant depression in autologous HCT 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 the hospital (MR, 0.98; 95% CI, 0.97-0.99; P = 0.002). CONCLUSION: Pre-transplant depression was associated with lower OS and higher risk of acute GVHD among allogeneic HCT recipients and fewer days alive and out of the hospital during the first 100 days after autologous and allogeneic HCT. Patients with pre-transplant depression represent a population that is at risk for post-transplant complications. Cancer 2017;123:1828–1838.",

keywords = "GVHD, autologous HCT, depression, pre-HCT depression, transplant outcomes",

author = "Areej El-Jawahri and Chen, {Yi Bin} and Ruta Brazauskas and Naya He and Lee, {Stephanie J.} and Knight, {Jennifer M.} and Navneet Majhail and David Buchbinder and Schears, {Raquel M.} and Wirk, {Baldeep M.} and Wood, {William A.} and Ibrahim Ahmed and Mahmoud Aljurf and Jeff Szer and Beattie, {Sara M.} and Minoo Battiwalla and Christopher Dandoy and Diaz, {Miguel Angel} and Anita D'Souza and Freytes, {Cesar O.} and James Gajewski and Usama Gergis and Hashmi, {Shahrukh K.} and Ann Jakubowski and Kamble, {Rammurti T.} and Tamila Kindwall-Keller and Lazarus, {Hilard M.} and Malone, {Adriana K.} and Marks, {David I.} and Kenneth Meehan and Savani, {Bipin N.} and Olsson, {Richard F.} and David Rizzieri and Amir Steinberg and Dawn Speckhart and David Szwajcer and Helene Schoemans and Sachiko Seo and Celalettin Ustun and Yoshiko Atsuta and Jignesh Dalal and Carmem Sales-Bonfim and Nandita Khera and Theresa Hahn and Wael Saber",

note = "Publisher Copyright: {\textcopyright} 2016 American Cancer Society",

year = "2017",

month = may,

day = "15",

doi = "10.1002/cncr.30546",

language = "English (US)",

volume = "123",

pages = "1828--1838",

journal = "Cancer",

issn = "0008-543X",

publisher = "John Wiley and Sons Inc.",

number = "10",

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TY - JOUR

T1 - Impact of pre-transplant depression on outcomes of allogeneic and autologous hematopoietic stem cell transplantation

AU - El-Jawahri, Areej

AU - Chen, Yi Bin

AU - Brazauskas, Ruta

AU - He, Naya

AU - Lee, Stephanie J.

AU - Knight, Jennifer M.

AU - Majhail, Navneet

AU - Buchbinder, David

AU - Schears, Raquel M.

AU - Wirk, Baldeep M.

AU - Wood, William A.

AU - Ahmed, Ibrahim

AU - Aljurf, Mahmoud

AU - Szer, Jeff

AU - Beattie, Sara M.

AU - Battiwalla, Minoo

AU - Dandoy, Christopher

AU - Diaz, Miguel Angel

AU - D'Souza, Anita

AU - Freytes, Cesar O.

AU - Gajewski, James

AU - Gergis, Usama

AU - Hashmi, Shahrukh K.

AU - Jakubowski, Ann

AU - Kamble, Rammurti T.

AU - Kindwall-Keller, Tamila

AU - Lazarus, Hilard M.

AU - Malone, Adriana K.

AU - Marks, David I.

AU - Meehan, Kenneth

AU - Savani, Bipin N.

AU - Olsson, Richard F.

AU - Rizzieri, David

AU - Steinberg, Amir

AU - Speckhart, Dawn

AU - Szwajcer, David

AU - Schoemans, Helene

AU - Seo, Sachiko

AU - Ustun, Celalettin

AU - Atsuta, Yoshiko

AU - Dalal, Jignesh

AU - Sales-Bonfim, Carmem

AU - Khera, Nandita

AU - Hahn, Theresa

AU - Saber, Wael

PY - 2017/5/15

Y1 - 2017/5/15

N2 - BACKGROUND: To evaluate the impact of depression before autologous and allogeneic hematopoietic cell transplantation (HCT) on clinical outcomes post-transplantation. METHODS: We analyzed data from the Center for International Blood and Marrow Transplant Research to compare outcomes after autologous (n = 3786) or allogeneic (n = 7433) HCT for adult patients with hematologic malignancies with an existing diagnosis of pre-HCT depression requiring treatment versus those without pre-HCT depression. Using Cox regression models, we compared overall survival (OS) between patients with or without depression. We compared the number of days alive and out of the hospital in the first 100 days post-HCT using Poisson models. We also compared the incidence of grade 2-4 acute and chronic graft-versus-host disease (GVHD) in allogeneic HCT. RESULTS: The study included 1116 (15%) patients with pre-transplant depression and 6317 (85%) without depression who underwent allogeneic HCT between 2008 and 2012. Pre-transplant depression was 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 2-4 acute GVHD (HR, 1.25; 95% CI, 1.14-1.37; P < 0.0001), but similar incidence of chronic GVHD. Pre-transplant depression was associated with fewer days-alive-and-out-of-the hospital (means ratio [MR] = 0.97; 95% CI, 0.95-0.99; P = 0.004). There were 512 (13.5%) patients with Pre-transplant depression and 3274 (86.5%) without depression who underwent autologous HCT. Pre-transplant depression in autologous HCT 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 the hospital (MR, 0.98; 95% CI, 0.97-0.99; P = 0.002). CONCLUSION: Pre-transplant depression was associated with lower OS and higher risk of acute GVHD among allogeneic HCT recipients and fewer days alive and out of the hospital during the first 100 days after autologous and allogeneic HCT. Patients with pre-transplant depression represent a population that is at risk for post-transplant complications. Cancer 2017;123:1828–1838.

AB - BACKGROUND: To evaluate the impact of depression before autologous and allogeneic hematopoietic cell transplantation (HCT) on clinical outcomes post-transplantation. METHODS: We analyzed data from the Center for International Blood and Marrow Transplant Research to compare outcomes after autologous (n = 3786) or allogeneic (n = 7433) HCT for adult patients with hematologic malignancies with an existing diagnosis of pre-HCT depression requiring treatment versus those without pre-HCT depression. Using Cox regression models, we compared overall survival (OS) between patients with or without depression. We compared the number of days alive and out of the hospital in the first 100 days post-HCT using Poisson models. We also compared the incidence of grade 2-4 acute and chronic graft-versus-host disease (GVHD) in allogeneic HCT. RESULTS: The study included 1116 (15%) patients with pre-transplant depression and 6317 (85%) without depression who underwent allogeneic HCT between 2008 and 2012. Pre-transplant depression was 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 2-4 acute GVHD (HR, 1.25; 95% CI, 1.14-1.37; P < 0.0001), but similar incidence of chronic GVHD. Pre-transplant depression was associated with fewer days-alive-and-out-of-the hospital (means ratio [MR] = 0.97; 95% CI, 0.95-0.99; P = 0.004). There were 512 (13.5%) patients with Pre-transplant depression and 3274 (86.5%) without depression who underwent autologous HCT. Pre-transplant depression in autologous HCT 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 the hospital (MR, 0.98; 95% CI, 0.97-0.99; P = 0.002). CONCLUSION: Pre-transplant depression was associated with lower OS and higher risk of acute GVHD among allogeneic HCT recipients and fewer days alive and out of the hospital during the first 100 days after autologous and allogeneic HCT. Patients with pre-transplant depression represent a population that is at risk for post-transplant complications. Cancer 2017;123:1828–1838.

KW - GVHD

KW - autologous HCT

KW - depression

KW - pre-HCT depression

KW - transplant outcomes

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U2 - 10.1002/cncr.30546

DO - 10.1002/cncr.30546

M3 - Article

C2 - 28102896

AN - SCOPUS:85010190159

SN - 0008-543X

VL - 123

SP - 1828

EP - 1838

JO - Cancer

JF - Cancer

IS - 10

ER -

Impact of pre-transplant depression on outcomes of allogeneic and autologous hematopoietic stem cell transplantation

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