ORIGINAL ARTICLE
Quality of life and social integration after allogeneic hematopoietic SCT
S Bieri1, E Roosnek2, C Helg2, F Verholen2, D Robert2, B Chapuis2, J Passweg2, R Miralbell1
and Y Chalandon2
1Division of Radiation Oncology, Department of Radiology, University Hospital, Geneva, Switzerland and 2Division of Hematology,
Department of Internal Medicine, University Hospital, Geneva, Switzerland
In total, 124 adult patients in remission after allogeneic
hematopoietic SCT (HSCT) participated in a cross-
sectional study to assess health-related quality of life
(HRQL). Assessment of HRQL was carried out using two
questionnaires: the (EORTC QLQ-C30) and the Func-
tional Assessment of Cancer Therapy (FACT) with
specific modules for BMT (FACT-BMT). Transplanted
patients differed from healthy controls in many HRQL-
related dimensions in the EORTC QLQ-C30: social
functioning 73.4 versus 85.8, Po0.0001; role functioning
74.6 versus 83.3, Po0.004; physical functioning 83.9
versus 89.9, Po0.001; emotional functioning 72.2 versus
82.8, Po0.0001 but were not significant for global
HRQL 71.2 versus 75.3, Po0.03. In total, 60% of the
patients returned to work after HSCT; 31% part time and
29% full time. Age at HSCT and employment status were
significantly associated with HRQL. Other factors such
as disease and disease stage and especially the occurrence
of late complications did not impact the perception of
HRQL. This study suggests that the perception of HRQL
after HSCT differs from the general population. Issues to
increase work-related capabilities and improve social
support need to be addressed.
Bone Marrow Transplantation (2008) 42, 819–827;
doi:10.1038/bmt.2008.253; published online 18 August 2008
Keywords: quality of life; allo-SCT; employment status
Introduction
There has been a growing interest in quality-of-life
evaluation following cancer treatment, including hemato-
poietic SCT (HSCT).1–3 Information about health-related
quality of life (HRQL) provides a broader understanding of
the patient’s status after treatment beyond simple disease-
free survival time. Hence, HRQL is now considered an
index of the effectiveness of treatment and should become
an integral component in the assessment of medical
outcome. HRQL is a multidimensional phenomenon
consisting of physical, psychological and social components
following HSCT. Individual HRQL may be affected in any
or all of these three areas. Accurate information regarding
the HRQL is essential for programs devoted to inform
potential transplant recipients and family members who are
attempting to make decisions regarding HSCT. Awareness
of long-term effects (including psychosocial distress) that
may affect HRQL can also guide program revisions to
decrease potential problematic side effects.1,3–7
The aim of this study was to assess HRQL using the
Functional Assessment of Cancer Therapy scale with
specific modules for BMT (FACT-BMT) and the European
Organization for Research and Treatment of Cancer
(EORTC QLQ-C30) questionnaires in patients of a single
institution after allogeneic HSCT and free of disease at the
time of evaluation. These two instruments focus possibly
on different aspects of HRQL.8,9 These results were
compared with those obtained from healthy controls.
In addition, information on long-term effects, social issues,
demographic and work-related variables was included.
Patients and methods
Patients
Eligible patients had undergone allogeneic HSCT between
1984 and 2004 at the University Hospital of Geneva,
without evidence of persistent or recurrent disease at the
time of answering the questionnaire (March 2005). Patients
were French-, German- or English-speaking Swiss resi-
dents. The Institutional Ethics Committee approved the
protocol and participants consented to this study. All
patients were followed regularly in the outpatient facility.
Patients completed the self-assessment questionnaires
(EORTC QLQ-C30 (version 3) and the FACT-BMT) and
mailed them back to the principle investigator. Patients had
the opportunity to contact the investigators to address any
question they might have and to receive additional help to
answer the survey if necessary. Employment and marital
status prior to transplant and at the time of the present
survey were included in the questionnaire. Questionnaires
were sent out in March 2005. Clinical data were obtained
from medical charts or retrieved from the transplant
program database.
Received 23 November 2007; revised 2 July 2008; accepted 2 July 2008;
published online 18 August 2008
Correspondence: Dr Y Chalandon, Internal Medicine, Division of
Hematology, University Hospital, 24 rue Micheli-du-Crest, Geneva
1211, Switzerland.
E-mail: yves.chalandon@hcuge.ch
Bone Marrow Transplantation (2008) 42, 819–827
& 2008 Macmillan Publishers Limited All rights reserved 0268-3369/08 $32.00
www.nature.com/bmt

Out of 316 recipients of allogeneic HSCT between 1984
and 2004, 134 patients, alive, without evidence of disease,
and eligible for this study were contacted and 124 (94%)
patients participated in the study. The median time from
HSCT was 7.3 years (interval 1–21 years). The time interval
from HSCT to assessment waso5 years for 48 patients and
45 years for 76 patients. Patient and treatment character-
istics are given in Table 1. Low-risk patients were defined as
patients either in first CR of acute leukemia, or in the first
chronic phase of CML at the time of transplant or with
aplastic anemia. All other patients were considered high risk.
Treatment characteristics
Pre-transplant conditioning was by standard (n¼ 105) or
reduced (n¼ 13) intensity. Standard conditioning was either
based on TBI (n¼ 90) or on chemotherapy alone (n¼ 15).
TBI for standard conditioning was delivered in six
fractions, two fractions per day separated by at least 8 h.
The lung dose was always limited to a maximum dose of
10Gy by customized blocks.10 The prescribed dose was 10,
12 or 13.5Gy according to successive conditioning proto-
cols and patient age.11,12 GVHD prophylaxis consisted
of T-cell depletion by Campath 1H with or without T cell
add-back in addition to CYA with methotrexate or with
mycophenolate or no additional treatment.13,14 In total, 22
high-risk patients had a T-cell replete graft with standard
GVHD prophylaxis with CYA and methotrexate. GVHD
was graded according to standard criteria.15
Late complications
Late complications were defined as chronic GVHD of any
grade, visual impairment, cataract, avascular osteonecrosis
or other bone events, pain and/or weakness related to
peripheral neuropathy or neurological impairment, clinical
depression and secondary malignancies.
The median age at time of answering the questionnaire
was 42 years (range: 19–67 years). Median Karnofsky
performance score16 at that time was 90 (range: 50–100).
A total of 115 late complications occurring in 57 patients
were recorded and are summarized in Table 1. Chronic
GVHD was observed in 27% of the patients (limited
disease in 22 patients and extensive disease in 12 patients).
Forty patients (32%) developed ocular side effects: cataract
was diagnosed in 24 patients (19%), 16 patients presented
with other ocular impairment, sicca syndrome (positive
Schirmer’s test) and corneal damage, and 1 patient was
blind due to bilateral viral chorioretinitis. Eleven patients
(9%) presented with some degree of neurological impair-
ment. Seven patients had distal leg pain and hypoesthesia,
including one patient with bilateral weakness in the
popliteal sciatic nerve territory. One patient each had a
transient ischemic attack and a toxic acute transverse spinal
cord syndrome with paraplegia and hearing loss. Depres-
sive disorders requiring psychological and pharmacological
support were diagnosed in 15 patients (12%). Five patients
presented with seven major bone complications, including
bilateral femoral head osteonecrosis and pathological
fractures. Ten patients (8%) developed a secondary
malignancy: muco-epidermoid carcinoma of the parotid
gland (2), localized prostate adenocarcinoma (2), poorly
differentiated endocervical adenocarcinoma (1), lower limb
osteosarcoma (1), breast cancer (1), follicular-derived
papillary carcinoma of the thyroid (1) and malignant
melanoma (2).
Table 1 Patients (124), treatment characteristics and late compli-
cations
Number of
patients
Median age (range) (years) 34 (14–65)
Gender (men/women) 79/45
Median Karnofsky score (range) 90 (50–100)
90–100 63
80–90 41
o80 20
Median time between diagnosis and HSCT (range)
(months)
9 (1–315)
Median time between HSCT and interview (range)
(years)
7 (1–21)
Primary diagnoses
AML 40
ALL 20
CML 31
CLL 1
Myelodysplasic syndrome (MDS) 8
Lymphoma 14
Myeloma (M) 1
Myeloproliferative syndrome (MPS) 3
Aplastic anemia (AA) 6
Risk category
Standard risk 73
High risk 51
Stem cell source
BM 62
PBSC 62
T depletion
T-depleted 54
Non-T-depleted 22
Partially T-depleted 48
Conditioning regimen
TBI+chemotherapy 97
Busulfan (ablative)+other chemotherapy 27
Reduced intensity 13
Donor–recipient pairs
HLA identical 95
HLA-matched/unrelated 15
HLA-mismatched/related 5
HLA-mismatched/unrelated 8
Syngeneic 1
GVHD prophylaxis
Cyclosporine 44
Cyclosporine/methotrexate 32
No other than T depletion 48
Late complications
Chronic GVHD (any grade) 34
Ocular events (other than cataract) 16
Cataract 24
Neurological events 11
Bone and joint events 5
Depression 15
Secondary malignancy 10
Abbreviation: HSCT¼ hematopoietic SCT.
Professional reintegration after BMT
S Bieri et al
820
Bone Marrow Transplantation