Mental health check needed before allogeneic HSCT

Depression before transplantation may compound mortality risks in patients receiving allogeneic haematopoietic stem cell transplantation (allo-HSCT), a recent study has found.

Researchers conducted a nationwide cohort study including 7,170 patients (median age at transplant, 45 years; 54.6 percent male) who received all-HSCT between 2002 and 2018 in South Korea. Of the participants, 13.3 percent (n=956) had depression, and the remaining 86.7 percent (n=6,214) did not. The primary endpoint was overall survival (OS) difference post-transplantation between depression status groups.

Over a median of 29.1 months, a 5-year OS rate estimate of 63.1 percent was calculated. Patients with depression or anxiety before transplantation showed lower 5-year survival rates; those with both psychological morbidities had the worst outlook.

Multivariable analysis confirmed that having pretransplantation depression (adjusted hazard ratio [HR], 1.167, 95 percent confidence interval [CI], 1.007–1.352; p=0.04) and both depression and anxiety (adjusted HR, 1.202, 95 percent CI, 1.038–1.393; p=0.014) were correlated with significantly worse OS relative to patients who had neither. Anxiety alone, on the other hand, bore no such effect (adjusted HR, 1.038, 95 percent CI, 0.927–1.162; p=0.519).

At 100 days after transplantation, 6,391 patients were still alive and were eligible for the landmark analysis. Multivariable analysis showed that having both depression and anxiety remained a significant risk factor for worse OS (adjusted HR, 1.253, 95 percent CI, 1.061–1.479; p<0.001), while the effects of depression alone or anxiety alone were attenuated.