Author

Saunders Hsu

Date

May 2007

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Since 1979, children and adolescents enrolled on Children Cancer Group (CCG) clinical trials with a complete HLA-matched sibling were assigned to undergo allogeneic bone marrow transplantation (allo-BMT) for consolidation therapy. Patients who did not have a matched sibling went on to receive consolidation chemotherapy (CCT). Some studies, but not all, have shown that patients treated with allo-BMT have a significantly higher rate of survival compared to consolidation with CCT. However, allo-BMT is also associated with significant long-term side effects unique to transplantation, such as chronic graft versus host disease ( cGVHD). This study will contribute to our understanding of the long-term impact of treatment in survivors of pediatric AML. It is hypothesized that post-induction allo-BMT is associated with a diminished QOL in survivors compared to treatment with CCT. Because the two therapies are marginally different in terms of overall survival, knowledge about quality of life (QOL) outcome may be useful to physicians and families when deciding between the two options. The research reported herein was part of a multi-dimensional study ofHRQL sponsored by the Children's Cancer Group (CCG) titled "Quality of Life Following Successful Therapy for Acute Myelogenous Leukemia: A Comparison of Bone Marrow Transplant and Chemotherapy." One of the instruments was the Profile of Mood States (POMS), a 65-item, adjective rating scale used to measure six mood states (tension/anxiety, depression, anger, confusion, vigor, and fatigue) and calculate the total mood disturbance (TMD) score. The dependent variables were the POMS scores, and the principle independent variable was the treatment variable (allo-BMT or non-allo-BMT). Additional independent variables include the demographic and clinical data. There were 124 Profile of Mood States (POMS) questionnaires scored; 51 underwent allo-BMT, and 73 received autologous BMT or CCT. No statistically significant differences were found in the POMS scores between the two treatment groups. The subjects' gender was associated with the vigor score, but none of the other POMS scores. Race, age at diagnosis, time elapsed from diagnosis, and history of relapse were not associated with POMS scores. Among those that received allo-BMT, relapse was significantly associated with the outcomes depression, anger, and TMD; cGVDH was significantly associated with the outcomes depression, confusion, and TMD; TBI was not associated with any POMS outcomes. POMS scores in this sample of AML survivors were similar to those in the general population. Based on this study, it is reassuring to know that childhood AML survivors are not having excess problems with mood disturbance compared to their peers, and there is no statistically significant difference in mood disturbance score whether one received an allo-BMT or not. Therefore, this aspect of HRQL need not factor into the decision process for the type of post-remission treatment a patient receives.

Identifier

doi:10.6083/M4V40S65

School

School of Medicine

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