Graft versus host disease as a marker for assessing quality of life in patients after allogeneic hematopoietic cell transplantation –⁠ results of a retrospective study

Czech version

Authors: MUDr. Simona Pavúková ^1,2; MUDr. Roman Králik ¹; MUDr. Dana Dudová ¹; prof. MUDr. Juraj Payer, PhD., MPH, FRCP, FEFIM1 ¹; doc. MUDr. Ľuboš Drgoňa, CSc., MHA, FECMM2 ²
Authors‘ workplace: V. interná klinika LF UK a UNB, Nemocnica Ružinov, Bratislava, Slovensko ¹; Klinika onkohematológie LF UK a NOÚ, Bratislava, Slovensko ²
Published in: Klin Onkol 2026; 39(5): 331-336
Category: Original Articles
doi: https://doi.org/10.48095/ccko2026331

Overview

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) represents a potentially curative treatment for hematological malignancies and selected non-malignant diseases, but it is associated with significant morbidity. Graft versus host disease (GvHD) is a major cause of mortality and impaired quality of life (QoL) after allo-HSCT, affecting 20–50% of transplant recipients. Patient QoL is a key indicator of transplantation success, with GvHD representing its most significant negative predictor. Both acute and chronic GvHD pose substantial threats to QoL, with chronic GvHD considered as the main cause of long-term morbidity and mortality. Our findings indicate that every patient in the studied cohort experienced at least three complications related to treatment and allo-HSCT itself. Notably, even mild health deterioration and mild organ impairment of the lungs, gastrointestinal tract, and musculoskeletal system were associated with clinically significant declines in physical QoL.

Keywords:

GVHD – Quality of life – allogeneic transplantation – HRQoL

Sources

1. World Health Organization. WHOQOL: Measuring Quality of Life. Geneva: World Health Organisation 2019. [online]. Available from: https: //www.who.int/tools/whoqol.

2. Eurostat. Final report of the expert group on quality of life indicators –⁠ 2017 edition. Luxembourg: Publications Office of the European Union 2017. [online]. Available from: https: //ec.europa.eu/eurostat/documents/7870049/7960327/KS-FT-17-004-EN-N.pdf/f29171db-e1a9-4af6-9e96-730e7e11e02f?t=1490716665000.

3. Haraldstad K, Wahl A, Andenæs R et al. A systematic review of quality of life research in medicine and health sciences. Qual Life Res 2019; 28 (10): 2641–2650. doi: 10.1007/s11136-019-02214-9.

4. Sadovská M. Hodnotenie kvality života hospitalizovaných onkologických pacientov v paliatívnej starostlivosti. Paliat Med Liec Boles 2012; 5 (2): 62–66.

5. Yin S, Njai R, Barker L et al. Summarizing health-related quality of life (HRQOL): development and testing of a one-factor model. Popul Health Metr 2016; 14 : 22. doi: 10.1186/s12963-016-0091-3.

6. Bower H, Björkholm M, Dickman PW et al. Life expectancy of patients with chronic myeloid leukemia approaches the life expectancy of the general population. J Clin Oncol 2016; 34 (24): 2851–2857. doi: 10.1200/JCO.2015.66.2866.

7. Al Hadidi S, Kamble RT, Carrum G et al. Assessment and reporting of quality-of-life measures in pivotal clinical trials of hematological malignancies. Blood Adv 2021; 5 (22): 4630–4633. doi: 10.1182/bloodadvances.2021004190.

8. Ayana BA, Negash S, Yusuf L et al. Reliability and validity of amharic version of EORTC QLQ-C 30 questionnaire among gynecological cancer patients in Ethiopia. PLoS One 2016; 11 (6): e0157359. doi: 10.1371/journal.pone.0157359.

9. Sureda A, Bader P, Cesaro S et al. Indications for allo -⁠ and auto-SCT for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2015. Bone Marrow Transplant 2015; 50 (8): 1037–1056. doi: 10.1038/bmt.2015.6.

10. Jílek P. Imunologie stručně, jasně, přehledně. 4. vyd. Praha: Grada 2014. 96 s.

11. Dalle JH, Giralt SA. Hepatic veno-occlusive disease after hematopoietic stem cell transplantation: risk factors and stratification, prophylaxis, and treatment. Biol Blood Marrow Transplant 2016; 22 (3): 400–409. doi: 10.1016/j.bbmt.2015.09.024.

12. Khimani F, McDonald GB, Shulman HM et al. Hepatic veno-occlusive disease following sirolimus-based immune suppression. Bone Marrow Transplant 2019; 54 (1): 85–89. doi: 10.1038/s41409-018-0233-2.

13. Thangavelu G, Blazar BR. Achievement of tolerance induction to prevent acute graft-vs.-host disease. Front Immunol 2019; 10 : 309. doi: 10.3389/fimmu.2019.00309.

14. Lee SJ, Onstad L, Chow EJ et al. Patient-reported outcomes and health status associated with chronic graft-versus-host disease. Haematologica 2018; 103 (9): 1535–1541. doi: 10.3324/haematol.2018.192930.

15. Rohoň P et al. Nové možnosti v léčbě vybraných hematologických onemocnění. Praha: Mladá fronta 2016 : 18–20.

16. Omer AK, Weisdorf DJ, Lazaryan A et al. Late acute graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2016; 22 (5): 879–883. doi: 10.1016/j.bbmt.2015.12.020.

17. Riwes R, Reddy P. Microbial metabolites and graft versus host disease. Am J Transplant 2018; 18 (1): 23–29. doi: 10.1111/ajt.14443.

18. Salas MQ, Cascos E, López-García A et al. Cardiac events occurring after allogeneic hematopoietic cell transplantation with post-transplant cyclophosphamide: Study conducted on behalf of the GETH-TC. Bone Marrow Transplant 2024; 59 (12): 1694–1703. doi: 10.1038/s41409-024-02414-z.

19. Sakellari I, Barbouti A, Bamichas G et al. GVHD-associated chronic kidney disease after allogeneic haematopoietic cell transplantation. Bone Marrow Transplant 2013; 48 (10): 1329–1334. doi: 10.1038/bmt.2013.55.

20. Tichelli A, Duell T, Weiss M et al. Late-onset kerato--conjunctivitis sicca syndrome after bone marrow transplantation: incidence and risk factors. European Group or Blood and Marrow Transplantation (EBMT) Working Party on Late Effects. Bone Marrow Transplant 1996; 17 (6): 1105–1111.

21. Koeppen S, Thirugnanasambanthan A, Koldehoff M. Neuromuscular complications after hematopoietic stem cell transplantation. Support Care Cancer 2014; 22 (9): 2337–2241. doi: 10.1007/s00520-014-2225-0.

22. Brice L, Gilroy L, Panello JM et al. Fear of cancer recurrence following allogeneic haematopoietic stem cell transplantation (HSCT) for haematological malignancy: a cross-sectional study. Eur J Oncol Nurs 2020; 49 : 101845. doi: 10.1016/j.ejon.2020.101845.

23. Wu X, Xu Q. Cancer-related fatigue in patients undergoing hematopoietic stem cell transplant: a cross-sectional study on prevalence and influencing factors. Front Psychiatry 2025; 16 : 1681573. doi: 10.3389/fpsyt.2025.1681573.