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Stem Cell Transplant Patients Die Sooner If Depressed

Do blood cancer patients who receive stem cell transplants die earlier if they are depressed? And if so, would treatment for depression lengthen their lives?

Researchers at the International Bone Marrow Transplant Registry (IBMTR) at the Medical College of Wisconsin in Milwaukee, and at the Dana-Farber Cancer Institute found that patients with depressive symptoms six months after their transplant have three times higher risk of death by one year post-transplant than do non-depressed patients.

The results of the study were presented Monday (Dec. 10) at the annual meeting of the American Society of Hematology, held at the Orange County Convention Center in Orlando, Fl.

The association between depression and increased mortality is well documented; it has held true with heart disease, cancer, and solid organ transplant patients. But it has not been extensively studied in stem cell transplant patients.

The information comes from a statistical analysis of the survival rates of patients with and without depressive symptoms who have had stem cell transplants.

"It is not routine for patients to have a formal psychological screening before stem cell transplants and depression following transplant may not be recognized," says Fausto Loberiza, M.D., M.S., assistant professor of health policy at the Medical College. "Our finding that patients who are depressed have higher death rates should lead to the next obvious question: could efforts to diagnose and treat depression improve survival rates?"

The study looked at 313 adult patients with different types of leukemia, myeloma and lymphoma who had received either autologous or allogeneic transplants at the Dana-Farber Cancer Institute as treatment for their cancers.

The patients filled out a Likert-scale symptom checklist and other quality of life instruments. Sixty-seven patients (35 percent) had symptoms associated with depression.

Researchers looked at both the depressed and non-depressed patients again at one year post-transplant. About 70 percent of the patients who were depressed at six months were still depressed at one year. Other medical factors were controlled for to allow the analysis to focus on depression.

The statistical analysis found the survival rate for depressed patients was 85 percent, while the survival rate for non-depressed patients was 94 percent. That difference, nine percent, is statistically significant.

"These data will help us plan further studies to see if survival rates improve if transplant patients are screened for depression and receive some sort of intervention," Dr. Loberiza says. That might include anti-depressant medication, psychotherapy, joining a support group or some other form of psychological support.

Research team members along with Dr. Loberiza are: Stephanie Lee, M.D., M.P.H., assistant professor of medicine at Dana-Farber Cancer Institute; J. Douglas Rizzo, M.D. and Christopher Bredson, M.D., M.S., assistant professors of medicine at the Medical College; Joseph Antin, M.D., associate professor of medicine at Dana-Farber Cancer Institute; Mary Horowitz, M.D., M.S., professor of neoplastic diseases and scientific director of the IBMTR at the Medical College and Jane Weeks, M.D., M.Sc., professor of medicine at Dana-Farber Cancer Institute.

The Medical College of Wisconsin, in collaboration with the National Marrow Donor Program and the EMMES Corp., has received an $11 million federal grant to coordinate medical studies around the nation involving blood stem cell transplants. The Medical College is already home to two international blood and bone marrow registries.

The new national Blood and Marrow Transplant Clinical Trials Network will be an umbrella group that runs studies at a host of major universities, cancer centers and research consortia. Similar cooperative groups already exist for cancer experiments; this will be the first of its kind specifically for blood transplants, said Mary Horowitz, scientific director of the registries and professor of neoplastics at the Medical College, who will lead the coordinating effort.

"We will be designing trials to evaluate issues in blood and marrow transplantation," she said. "Doing such studies at many centers simultaneously and pooling results should greatly increase our ability to develop and evaluate new drugs and treatment strategies." - By Toranj Marphetia


[Contact: Toranj Marphetia]

12-Dec-2001

 

 

 

 

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