Sleep disruption, fatigue predict long-term risks of relapse, mortality after HCT

Among patients who have undergone allogeneic haematopoietic stem cell transplantation (HCT), biobehavioural symptoms, such as sleep disruption and fatigue interference, may signal a heightened risk of relapse and mortality over 6 years following HCT, according to a study.

The analysis included 241 adults who received allogeneic HCT for a haematologic malignancy. They completed self-report measures of depression symptoms, sleep quality, and fatigue (severity, interference) prior to HCT and 100 days after the procedure. Follow-up for clinical outcomes lasted up to 6 years.

Multivariable Cox proportional hazard models controlled for patient demographic and medical characteristics showed that the risk of mortality was independently associated with high pre-HCT sleep disruption (Pittsburgh Sleep Quality Index >9; hazard ratio [HR], 2.74, 95 percent confidence interval [CI], 1.27–5.92) and greater post-HCT fatigue interference (HR, 1.32, 95 percent CI, 1.05–1.66).

Meanwhile, moderate pre-HCT sleep disruption (Pittsburgh Sleep Quality Index 6–9) emerged as a risk factor for relapse (HR, 1.99, 95 percent CI, 1.02–3.87).

Biobehavioural symptoms had no association with the incidence of chronic graft-versus-host disease (cGVHD).

The findings indicate that the identified predictors of an increased risk for 6-year relapse and mortality after HCT are amenable to treatment. As such, they offer specific targets for intervention to improve HCT outcomes.