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Im A, Mitchell SA, Steinberg SM, Curtis L, Berger A, Baird K, Kuzmina Z, Joe G, Comis LE, Juckett M, Avila D, Baruffaldi J, Masuch L, Pirsl F, Pavletic SZ. Prevalence and determinants of fatigue in patients with moderate to severe chronic GvHD. Bone Marrow Transplant 2016; 51:705-12. [PMID: 26828906 DOI: 10.1038/bmt.2015.320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/19/2015] [Accepted: 11/05/2015] [Indexed: 11/09/2022]
Abstract
Although fatigue is common after allogeneic hematopoietic cell transplantation, little is known about fatigue in patients with chronic GvHD (cGvHD). The aim of this study was to explore factors associated with fatigue in cGvHD. Data were drawn from a sequentially recruited, cross-sectional study of adults with moderate or severe cGvHD (n=263). Respondents were classified as fatigued or not fatigued based on their response to a single item regarding loss of energy from the Lee cGvHD Symptom Scale. In univariate analysis, factors significantly associated with fatigue included performance status, number of prior cGvHD therapies, cGvHD symptom bother, self-assessed physical and mental health, nutritional status, walk velocity and self-reported physical activity. There were no significant associations between fatigue and disease-related cGvHD variables. Multivariable logistic regression demonstrated that being less active and having pulmonary and/or muscle/joint symptoms were independently associated with fatigue. In conclusion, clinically significant fatigue was prevalent in more than one-third of subjects with cGvHD, and was disabling. Absence of association with measures of cGvHD severity underscores the need to elucidate the pathogenesis of fatigue and its relationship with inflammatory activity. Pulmonary and muscle/joint symptoms and physical inactivity represent potential targets for intervention in clinical studies.
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Affiliation(s)
- A Im
- Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - S A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Rockville, MD, USA
| | - S M Steinberg
- Biostatistics and Data Management Section, Office of the Clinical Director, National Cancer Institute, NIH, Bethesda, MD, USA
| | - L Curtis
- Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - A Berger
- Pain and Palliative Care, Clinical Center, NIH, Bethesda, MD, USA
| | - K Baird
- Pediatric Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Z Kuzmina
- Oncology/Hematology, Hospital Hietzing, Vienna, Austria
| | - G Joe
- Rehabilitation Medicine Department, NIH, Bethesda, MD, USA
| | - L E Comis
- Rehabilitation Medicine Department, NIH, Bethesda, MD, USA
| | - M Juckett
- Division of Hematology and Medical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - D Avila
- Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - J Baruffaldi
- Clinical Research Directorate/CMRP, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - L Masuch
- Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - F Pirsl
- Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - S Z Pavletic
- Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
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Curtis LM, Grkovic L, Mitchell SA, Steinberg SM, Cowen EW, Datiles MB, Mays J, Bassim C, Joe G, Comis LE, Berger A, Avila D, Taylor T, Pulanic D, Cole K, Baruffaldi J, Fowler DH, Gress RE, Pavletic SZ. NIH response criteria measures are associated with important parameters of disease severity in patients with chronic GVHD. Bone Marrow Transplant 2014; 49:1513-20. [PMID: 25153693 DOI: 10.1038/bmt.2014.188] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/02/2014] [Accepted: 07/10/2014] [Indexed: 11/09/2022]
Abstract
Lack of standardized criteria measuring therapeutic response remains an obstacle to the development of better treatments for chronic GVHD (cGVHD). This cross-sectional prospective study examined the concurrent and predictive validity of 18 clinician-reported ('Form A') and 8 patient-reported ('Form B') response measures proposed by NIH criteria. Concurrent parameters of interest were NIH global score, cGVHD activity, Lee symptom score and SF36 PCS. Patient cohort included 193 adults with moderate-to-severe cGVHD. Measures associated with the highest number of outcomes were lung function score (LFS), 2-min walk, grip strength, 4-point health-care provider (HCP) and patient global scores, 11-point clinician- and patient-reported global symptom severity scores, and Karnofsky performance score (KPS). Measures associated with survival in univariate analyses led to a Cox model containing skin erythema, LFS, KPS, eosinophil count and interval from cGVHD diagnosis to enrollment as jointly associated with survival. In conclusion, 4-point HCP and patient global scores and 11-point clinician- and patient-reported global symptom severity scores are associated with the majority of concurrent outcomes. Skin erythema is a potentially reversible sign of cGVHD that is associated with survival. These results define a subset of measures that should be prioritized for evaluation in future studies.
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Affiliation(s)
- L M Curtis
- 1] Medical Oncology Service, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA [2] Experimental Transplantation and Immunology Branch, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - L Grkovic
- 1] Experimental Transplantation and Immunology Branch, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA [2] Department of Hematology, Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - S A Mitchell
- Outcomes Research Branch; Division of Cancer Control and Population Sciences, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - S M Steinberg
- Biostatistics and Data Management Section, National Institutes of Health, National Cancer Institute, Rockville, MD, USA
| | - E W Cowen
- Dermatology Branch, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - M B Datiles
- National Institutes of Health, National Eye Institute, Bethesda, MD, USA
| | - J Mays
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - C Bassim
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - G Joe
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - L E Comis
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - A Berger
- Pain and Palliative Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - D Avila
- Experimental Transplantation and Immunology Branch, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - T Taylor
- Experimental Transplantation and Immunology Branch, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - D Pulanic
- Department of Hematology, Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - K Cole
- Experimental Transplantation and Immunology Branch, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - J Baruffaldi
- Experimental Transplantation and Immunology Branch, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - D H Fowler
- Experimental Transplantation and Immunology Branch, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - R E Gress
- Experimental Transplantation and Immunology Branch, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - S Z Pavletic
- Experimental Transplantation and Immunology Branch, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
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