Determinants of functional performance in long-term survivors of allogeneic hematopoietic stem cell transplantation with chronic graft-versus-host disease (cGVHD)

被引：82

作者：

Mitchell, S. A. ^{[1
]}

Leidy, N. Kline ^{[2
]}

Mooney, K. H. ^{[3
]}

Dudley, W. N. ^{[4
]}

Beck, S. L. ^{[3
]}

LaStayo, P. C. ^{[5
]}

Cowen, E. W. ^{[6
]}

Palit, P. ^{[1
]}

Comis, L. E. ^{[7
]}

Krumlauf, M. C. ^{[1
]}

Avila, D. N. ^{[8
]}

Atlam, N. ^{[9
]}

Fowler, D. H. ^{[8
]}

Pavletic, S. Z. ^{[8
]}

机构：

[1] NIH, Ctr Clin, Rockville, MD 20852 USA

[2] United BioSource Ctr Hlth Outcomes Res Corp, Sci Affairs, Bethesda, MD USA

[3] Univ Utah, Coll Nursing, Salt Lake City, UT 84112 USA

[4] Univ N Carolina, Sch Hlth & Human Performance, Greensboro, NC 27412 USA

[5] Univ Utah, Dept Phys Therapy, Salt Lake City, UT USA

[6] NCI, Dermatol Branch, Bethesda, MD 20892 USA

[7] NIH, Ctr Clin, Bethesda, MD USA

[8] NCI, Expt Transplant & Immunol Branch, Bethesda, MD 20892 USA

[9] NCI, Biostat & Data Management Sect, Bethesda, MD 20892 USA

来源：

BONE MARROW TRANSPLANTATION | 2010年 / 45卷 / 04期

基金：

美国国家卫生研究院;

关键词：

functional status; chronic graft-versus-host disease; symptoms; survivorship; late effects; allogeneic hematopoietic stem cell transplantation; QUALITY-OF-LIFE; BONE-MARROW-TRANSPLANTATION; HEALTH SURVEY SF-36; CONSENSUS DEVELOPMENT PROJECT; WORKING GROUP-REPORT; 2-MINUTE WALK TEST; MYELOID-LEUKEMIA; SYMPTOM EXPERIENCE; COMORBIDITY INDEX; PHYSICAL FUNCTION;

D O I：

10.1038/bmt.2009.238

中图分类号：

Q6 [生物物理学];

学科分类号：

071011 ;

摘要：

This study examined factors accounting for functional performance limitations in 100 long-term survivors of allogeneic hematopoietic stem cell transplantation with chronic graft-versus-host disease (cGVHD). Functional performance, measured by the SF-36 physical component summary score, was substantially lower (mean = 36.8 +/- 10.7) than the US population norm of 50 (P < 0.001). The most severe decrements were in physical function (mean = 38.8 +/- 10.9) and physical role function (mean = 37.88 +/- 11.88); 68% of respondents exceeded the five-point threshold of minimum clinically important difference below the norm on these subscales. Controlling for age and gender, six variables explained 56% of the variance in functional performance: time since cGVHD diagnosis, cGVHD severity, intensity of immunosuppression, comorbidity, functional capacity (distance walked in 2min, grip strength, and range of motion), and cGVHD symptom bother (F = 11.26; P < 0.001). Significant independent predictors of impaired performance were intensive systemic immunosuppression, reduced capacity for ambulation, and greater cGVHD symptom bother (P < 0.05). Symptom bother had a direct effect on functional performance, as well as an indirect effect partially mediated by functional capacity (Sobel test, P = 0.004). Results suggest two possible mechanisms underlying impaired functional performance in survivors with cGVHD and underscore the importance of testing interventions to enhance functional capacity and reduce symptom bother. Bone Marrow Transplantation (2010) 45, 762-769; doi:10.1038/bmt.2009.238; published online 28 September 2009

引用

页码：762 / 769

页数：8

共 52 条

[1] QUALITY-OF-LIFE FOLLOWING BONE-MARROW TRANSPLANTATION - FINDINGS FROM A MULTICENTER STUDY [J].