Physical and not mental health is impaired in very long-term survivors after HSCT compared with their respective donors: a paired analysis

To the editor:

Bhatia and colleagues¹  recently published a comprehensive analysis on late mortality after allogeneic hematopoietic stem cell transplantation (HSCT), providing interesting data about the functional status of 547 recipients and 319 siblings. At the time of this Collaborative Bone Marrow Transplant Survivor Study, patients and donors had a median age of 41.5 and 44 years, respectively, and a median time of 8.6 years after HSCT. By questionnaire, long-term survivors reported significantly more difficulties in integration back into society after HSCT, in holding down employment, or in obtaining or retaining health insurance compared with their siblings. These results provided additional information to the relatively scarce and partially conflicting reports on functional status in the long-term recipients of HSCT surviving more than 10 years.^2,3 

In order to obtain a comprehensive overview on physical and mental health in very long-term survivors after HSCT, we invited 44 recipients and their respective HLA-identical sibling donors to take part in a prospective study at the University Hospital of Basel. Both the recipients and their donors were controlled at the same time point, in pairs, and were given a complete clinical and biologic examination. Each answered a Short Form 36 (SF-36) Health Survey,^4,5  which provides the generic health status measure using 36 items assessing 8 different concepts (Table 1). Three of the concepts provide a score for physical health, 3 for mental health, and 2 for general health status. These 8 concepts are summarized in 2 global tests, one for physical and one for mental health. Norm-based scores were used, in which 50 represents the mean score, and 10 the standard deviation for the general population. The median age of the recipients and donors at time of the study was 44.3 years (24-63) and 43.4 years (22-61), respectively, with a median time of 17.5 years (range, 11-26 years) after HSCT. Four patients received an HSCT for aplastic anemia and 40 for hematologic malignancies. All patients received bone marrow as stem cell source and total body irradiation was part of the conditioning in 39 patients (89%). Acute graft-versus-host disease (GVHD) was observed in 31 (70%), and chronic GVHD in 22 (50%) patients.

In a paired comparison, recipients showed a significantly lower rank of the norm-based scores for all questions related to physical well-being, except for role limitation, but no difference in the mental health scores compared with their respective donors (Table 1). This is confirmed by the global test for physical (P = .001) and mental (P = .831) health. Physical health was significantly lower in patients with extensive chronic GVHD (P = .05), in females (P = .024), in recipients older than 25 years at HSCT (P = .024) or older than 42 years at study evaluation (P = .05). None of these factors had an impact on mental heath status (MCS, P > .10). In summary, our data extend the findings reported by Bhatia et al¹  on the functional health status in long-term survivors, validating the finding that the physical health status of very long-term survivors after HSCT can be impaired, while mental health status remains preserved.