Analysis of the quality of life of oncohematological patients with neurological indications after allogeneic hematopoietic stem cell transplantation

Introduction. Given advances in hematological oncology and increased progression-free survival in patients with hematological diseases after allogeneic hematopoietic stem cell transplantation (allo-HSCT), assessing the quality of life of recipients who have experienced complications from treatment of the underlying disease has become an urgent issue.

The objective was to evaluate the quality of life of oncohematological patients with late neurological complications after allo-HSCT.

Methods and materials. The study included 157 patients (88 women, 69 men) with oncohematological diseases in the late (≥D+180) period after allo-HSCT (452±552.9 days) between 2022 and 2023.

Results. Pain of any localization was reported in 86 (54.8 %) patients. In this case, there were 74 (47.1 %) out of 157 patients with one complaint, 36 (22.9 %) with two, 18 (11.5 %) with three, 4 and 5-7 (4.4%) and 1 (0.6%), respectively. Incidence of the identified pathology: headache (not migraine) was recorded in 52 (33.1 %), polyneuropathy – 18 (11.5 %), neuropathy – 18 (11.5 %; cranial 2 (7.2 %), non-cranial 16 (10.2 %)), degenerative-dystrophic spine disease – 18 (11.5 %), encephalopathy – 12 (7.6 %), anxiety-depressive disorders, musculoskeletal disorders and benign muscle cramps – 10 each (6.4 % each), joint syndrome – 9 (5.7 %), myalgia – 7 (4.4 %), neurotoxicity – 6 (3.8 %), other – 17 (10.8 %). The likelihood of a poor physical component of health increases with age; in patients with musculoskeletal disorders and myalgia (36.17 vs. 43.58, p=0.001). The likelihood of poor mental health is associated with a diagnosis of encephalopathy (p=0.001) and increases in patients with neuropathy at all stages after HSCT, worsening at later stages (p<0.05) and with age. The likelihood of anxiety is higher in patients in the late post-HSCT period and in the presence of headache. The likelihood of depression in men is lower than in women (4.72 vs. 5.96), especially with a combination of neuropathy and headache.

Conclusion. The combination of several factors can significantly worsen the quality of life of allo-HSCT recipients with late neurological complications due to mutual aggravation. Depression was associated with the presence of cephalgic syndrome. Persistent pain syndromes are associated with a higher risk of anxiety and negatively impact on almost all aspects of quality of life. Factors affecting the physical component of health after allogeneic HSCT include musculoskeletal disorders and myalgia. The underlying hematological disease, patient age, and the presence of post-transplant complications are also associated with a decline in quality of life.

1. Kang J. M., Kim Y. J., Kim J. Y. et al. Neurologic complications after allogeneic hematopoietic stem cell transplantation in children: analysis of prognostic factors // Biol Blood Marrow Transplant. 2015;21(6):1091–8. https://doi.org/10.1016/j.bbmt.2015.02.007.

2. Balaguer-Rosello A., Bataller L., Piñana J. L. et al. Noninfectious Neurologic Complications after Allogeneic Hematopoietic Stem Cell Transplantation // Biol Blood Marrow Transplant. 2019;25(9):1818–1824. https://doi.org/10.1016/j.bbmt.2019.05.024.

3. Hays R. D., Sherbourne C. D., Mazel R. M. User’s Manual for Medical Outcomes Study (MOS) Core measures of health-related quality of life. RAND Corporation, 1995. MR-162-RC.

4. McQuellon R. P., Russell G. B., Cella D. F. et al. Quality of life measurement in bone marrow transplantation: development of the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) scale // Bone Marrow Transplant. 1997;19(4):357–68. https://doi.org/10.1038/sj.bmt.1700672.

5. Zigmond A. S., Snaith R. P. The hospital anxiety and depression scale // Acta Psychiatr Scand. 1983;67(6):361–70. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x. PMID: 6880820.

6. Skiba Ya. B., Polushin A. Yu., Vladovskaya M. D. Prevalence of different types of headaches in adult onco-haematological patients before allogeneic haematopoietic stem cell transplantation. Russian neurological journal. 2022;27(1):80–87. (In Russ.). https://doi.org/10.30629/2658-7947-2022-27-1-80-87.

7. Common Terminology Criteria for Adverse Events (CTCAE) Version 6.0 Updated: September 2, 2025. URL: https://dctd.cancer.gov/research/ctep-trials/for-sites/adverse-events (accessed: 18.02.26).

8. Polushin A. Yu., Skiba Ya. B., Vladovskaya M. D. Spectrum of neurological pathology in patients with malignant hematological diseases before the bone marrow transplantation // Gospitalnaya medicina nauka i practika 2023;6(6):47–56. (In Russ.). https://doi.org/10.34852/GM3CVKG.2023.48.45.059.

9. Kettyle G. Multidisciplinary Approach to Cancer Pain Management // Ulster Med J. 2023;92(1):55–58.

10. Tsang A., Von Korff M., Lee S. et al. Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders // J Pain. 2008;9(10):883–91. https://doi.org/10.1016/j.jpain.2008.05.005.

11. González Barón M., Feijóo M., Escobar Alvarez Y., ASTHENOS Group. An epidemiological study of the perception of asthenia by oncologists in cancer patients: POA study // Clin Transl Oncol. 2008;10(5):288–93. https://doi.org/10.1007/s12094-008-0199-4.

12. Wang J., Zhou B. Y., Lian C. L. et al. Evaluation of Subjective Sleep Disturbances in Cancer Patients: A Cross-Sectional Study in a Radiotherapy Department // Front Psychiatry. 2021;12):648896. https://doi.org/10.3389/fpsyt.2021.648896.

13. Williams A. M., van Wijngaarden E., Seplaki C. L. et al. Cognitive function in patients with chronic lymphocytic leukemia: a cross-sectional study examining effects of disease and treatment // Leuk Lymphoma. 2020;61(7):1627–1635. https://doi.org/10.1080/10428194.2020.1728748.

14. van der Veldt A. A., van den Eertwegh A. J., Hoekman K. et al. Reversible cognitive disorders after sunitinib for advanced renal cell cancer in patients with preexisting arteriosclerotic leukoencephalopathy // Ann Oncol. 2007;18(10):1747–50. https://doi.org/10.1093/annonc/mdm455.

15. Rodwin R. L., Kairalla J. A., Hibbitts E. et al. Persistence of Chemotherapy-Induced Peripheral Neuropathy Despite Vincristine Reduction in Childhood B-Acute Lymphoblastic Leukemia // J Natl Cancer Inst. 2022;114(8):1167–1175. https://doi.org/10.1093/jnci/djac095.

16. Yoon S. Y., Oh J. Neuropathic cancer pain: prevalence, pathophysiology, and management // Korean J Intern Med. 2018;33(6):1058–1069. https://doi.org/10.3904/kjim.2018.162.

17. Martinec R., Pinjatela R., Balen D. Quality of life in patients with rheumatoid arthritis - a preliminary study // Acta Clin Croat. 2019;58(1):157–166. https://doi.org/10.20471/acc.2019.58.01.20.

18. Maggioni F., Mantovan M. C., Rigotti P. et al. Headache in kidney transplantation // J Headache Pain. 2009;10(6):455–60. https://doi.org/10.1007/s10194-009-0148-9.

19. Sadighi Z. S., Ness K. K., Hudson M. M. et al. Headache types, related morbidity, and quality of life in survivors of childhood acute lymphoblastic leukemia: a prospective cross sectional study // Eur J Paediatr Neurol. 2014;18(6):722–9. https://doi.org/10.1016/j.ejpn.2014.06.006.

20. Arumugam M., Narayan S. K. Rethinking of the concepts: Migraine is an autoimmune disease? // Neurol. Psychiatry Brain Res. 2019;31):20–26. https://doi.org/10.1016/J. NPBR.2018.11.003.

21. Kuba K., Esser P., Mehnert A. et al. Depression and anxiety following hematopoietic stem cell transplantation: a prospective population-based study in Germany // Bone Marrow Transplant. 2017;52(12):1651–1657. https://doi.org/10.1038/bmt.2017.190.

22. Fenech A. L., Van Benschoten O., Jagielo A. D. et al. Post-Traumatic Stress Symptoms in Hematopoietic Stem Cell Transplant Recipients // Transplant Cell Ther. 2021;27(4):341. e1–341.e6. https://doi.org/10.1016/j.jtct.2021.01.011.

23. Jahangir S., Adjepong D., Al-Shami H. A., Malik B. H. Is There an Association Between Migraine and Major Depressive Disorder? A Narrative Review // Cureus. 2020;12(6): e8551. https://doi.org/10.7759/cureus.8551.

24. Edwards R. R., Haythornthwaite J. A., Sullivan M. J., Fillingim R. B. Catastrophizing as a mediator of sex differences in pain: differential effects for daily pain versus laboratory- induced pain // Pain. 2004;111(3):335–341. https://doi.org/10.1016/j.pain.2004.07.012. PMID: 15363877.

25. Chernaya M. E., Orlovskaya A. D., Polushin A. Yu. et al. Endocrine complications in the treatment of autoimmune diseases by high-dose immunosuppressive therapy with autologous hematopoietic stem cell transplantation // Endocrinology: News, Opinions, Training. 2023;12(2):69–77. (In Russ.). https://doi.org/10.33029/2304-9529-2023-12-2-69-77.

26.