Humanistic burden of patients with chronic graft-versus-host disease - systematic literature review of health-related quality of life and functional status

ABSTRACT

Introduction: Chronic graft-versus-host disease (GVHD) is a serious complication of allogeneic hematopoietic stem cell transplantation (HSCT). This study aims to provide a systematic overview of evidence on the health-related quality of life (HRQoL) and functional capacity of HSCT patients with National Institutes of Health (NIH)-defined chronic GVHD.

Areas covered: English-language articles published between 2007 and 2017 were searched using PubMed. Studies that used the 2005 or 2015 NIH consensus criteria for the diagnosis and staging of chronic GVHD and had a cohort size of at least 100 patients were included.

Expert opinion: Disease severity and organ involvement were the most important predictors of HRQoL and functionality in chronic GVHD patients. Further, identified predictors of HRQoL were nutrition status and functional capacity, while functional status was also associated with disease symptoms, nutrition status, age, and survival. Data regarding the effect of symptom bother on HRQoL were limited. Our findings confirm that the management of chronic GVHD should focus on improving not only clinical outcomes but also on HRQoL and functional capacity. Therefore, to evaluate new treatment options it is recommended to include patient relevant endpoints into prospective studies. This study also highlights the importance of nonpharmacological aspects in the management of chronic GVHD.

KEYWORDS:

• Chronic graft-versus-host disease
• functional status
• quality of life
• systematic literature review

Article highlights

• Findings from this review confirm that chronic GVHD adversely affects patients’ HRQoL and functional status. Disease severity and organ involvement are key predictors of these outcomes.

• The management of chronic GVHD patients should focus on improving not only clinical outcomes but also on HRQoL and functional capacity. Therefore, prospective studies should investigate patient relevant endpoints more closely.

• Based on current evidences, SF-36 alone or the FACT-BMT combined with the HAP are recommended to be used in clinical studies to measure HRQoL and functional capacity.

Declaration of interest

M Csanádi, T Ágh, and Z Voko are employees of Syreon Research Institute. Syreon Research Institute received grant from Janssen Global Services, LLC to conduct the study. N Sengupta, J Trudeau, and F Schain are employees of Janssen, Johnson and Johnson. F Schain is also a shareholder of Johnson and Johnson stocks. T Webb and D Jeyakumaran were Janssen employees at time of the manuscript preparation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Supplementary material

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Additional information

Funding

This research was financially supported by Janssen Global Services, LLC.