Return to Work after Allogeneic HSCT: Further Insights in the Patients-Related Predictive Factors (The SOPRALLO Project)

Introduction

Allogeneic hematopoietic stem cell transplantation (HSCT) has significantly extended lives of recipients, although long-term side effects and impaired quality of life (QoL) are common These issues can reduce patients' capacity to return to work (RTW). Understanding these factors is crucial for enhancing patient care and support systems post-transplantation.

Aim
The primary objective of this study is to identify the patient-related predictive factors to RTW, focusing mainly on QoL, cognitive and physiological problems.

Methods

Patients from the J. Bordet Institute who have been in complete remission for at least one year after allo-HSCT were enrolled in the study during their routine follow-up visits using a cross-sectional approach, and clinical data were collected retrospectively. Seven validated questionnaires (FACT-BMT, FACIT-F, Fact-Cog, Lee symptom scale for cGVHD, HADS, IOCv2, RTW-SE) and one homemade questionnaire were administered to the patients. In this preliminary analysis, we focused on the overall proportion of RTW and the time to RTW post-transplant, excluding those over 65 years and those not working before HSCT. For continuous variables, Wilcoxon or Kruskal-Wallis tests were used to compare between subjects who RTW or not; and the chi-square test for categorical variables. Kaplan Meier and Cox regression were used to estimate the time to RTW and evaluate its association with the predictive factors.

Results
Among the 168 patient files that met the inclusion criteria, 110 patients enrolled between September 2022 and July 2024 were eligible for evaluation. Of the 110 patients, 89 (81%) were of employment age, with 45% female and 55% male. The median age of the analyzed cohort was 47 years (range 18.0-65.0). Primary diagnoses included AML (41.6%), MDS (13.5%), lymphomas (20.3%), ALL (6.7%), CML (4.5%), MPN (7.9%), and others (2.2%). Transplant types were 58.4% MUD, 12.4% MMUD, 22.5% MSD, and 6.7% haplo BMT; 68.2% received RIC and 31.8% MAC conditioning. 29.2% of the patients had transplantation less than 2 years, 10.1% had transplantation between 2 and 5 years, and 48.3% more than 5 years prior to enrollment.

Fifty one (57%) of the 89 evaluable patients returned to work, with 69% achieving RTW within a year after HSCT. The estimated median time to RTW was 2 years. Evaluating time to RTW, the RTW rate for males was 62% higher than for females (p=0.10). Younger patients (18-45 years) had 91% higher rate of RTW relative to older patients (46-65 years) (p=0.03). The RTW- Self-efficacy score was a significant predictor for RTW (p=0.0002). When RTW is evaluated as a binary variable, patients who RTW had significantly better scores on the PWB (p<0.0001), FWB (p=0.0003), and BMTS (p<0.0001) compared to those who did not, as well as FACT BMT TOI (p<0.0001), FACT G (p=0.0032), and FACT BMT (p=0.0004). Patients who RTW reported significantly better scores on self-reported fatigue (FACIT FS, p=0.0001; FACIT F, p<0.0001; TOI and FACIT F, p=0.0004). RTW was associated with significantly greater perceived cognitive abilities (p=0.01) and perceived cognitive impairments (p=0.0056) compared to those who did not RTW. Notably, males had better scores in these measures (p=0.0052 and p=0.0002). Anxiety and depression levels were higher in patients who did not RTW (p=0.0164 and p=0.037, respectively). Patient-reported outcomes which were measured by Lee symptom scale for cGVHD were predictive for RTW (p=0.0043) and QoL parameters (p <0.0001, except SWB=0.0149).

Conclusions
Our preliminary analysis showed that patients who RTW reported better physical, functional, and BMT-specific QoL scores, as well as lower levels of fatigue and cognitive impairments. Anxiety and depression levels were notably higher among patients who did not RTW. These findings emphasize the importance of patient-reported outcomes in the return-to-work process and highlight the need for further study of the neuropsychological effects of allo-HSCT, as these areas remain major unmet needs.