HSCT Recipients Show Sustained Health Challenges Following Transplant

Recipients of hematopoietic stem cell transplantation may benefit from psychosocial interventions and supportive care following their procedure.

Patients with acute myeloid leukemia (AML) who received a hematopoietic stem cell transplant (HSCT) during the height of the COVID-19 pandemic experienced sustained physical and mental health challenges, even years following transplant, according to findings from a qualitative study presented at the 22nd Annual American Psychosocial Oncology Society (APOS) conference.¹

Results from the trial revealed common 3 common themes:

• Transplant is an arduous journey;
• The COVID-19 pandemic severely complicated the transplant experience;
• Transplant requires extensive dedication and commitment

Notably, within each theme, common subthemes emerged. For the first theme, the subthemes were as follows:

1. Physical debilitation during hospital stays and the first 100 days after treatment;
2. The impact of treatment on the social determinants of health;
3. The evolution of identity and interpersonal relationships and roles;
4. The uncertainty of treatment outcomes;
5. Coping with trauma and loss;
6. Existential questions and post-traumatic growth

The second theme had the following subthemes:

1. COVID-19’s impact on treatment progression;
2. The pandemics restriction of interpersonal activities and exacerbation of social isolation;
3. Any unexpected benefits that rose from pandemic-induced isolation

Additionally, the third theme was divided into these subthemes:

1. Transplant required continuous family caregiver presence and a holistic a approach;
2. Benefits of a social network;
3. A need for individualized support;
4. Spirituality, preserving attitudes, and the development of coping strategies;
5. Maintaining a commitment to self-care

“[Patients] endured trauma and loss, experienced changes in their identity and interpersonal relationships, and confronted existential questions [after transplant],” Natalie S. McAndrew, PhD, RN, ACNS-BC, CCRN-K, associate professor at the School of Nursing at the University of Wisconsin and nurse scientist at the Froedtert Hospital and the Medical College of Wisconsin, wrote in the presentation with study coinvestigators. “[Patients] wanted peer support, support for their families, resources for sexual health, and strategies to address the existential distress related to ongoing uncertainty inherent in HSCT.”

The qualitative study enrolled 75 patients AML in the US who underwent allogenic transplantation from March to September 2020. Patients were identified through the Center for International Blood and Marrow Transplant Research (CIBMTR) registry as part of a parent study based on survey responses: patients who answered “yes” to a question about a willingness to participate in an individual interview were contacted. Interviews were conducted via video conferencing and recorded, with a transcription service transcribing responses verbatim.

The study was initiated to gain insight from patients who received HSCT during the height of the COVID-19 pandemic to elucidate the impact of prolonged isolation and limited support. The study aimed to describe the experiences of patients who underwent HSCT during the initial months of the COVID-19 pandemic and then to identify specific resilience or risk factors through individual testimony.

A total of 25 patients who previously received HSCT completed an interview, with a median age of 59 years (range, 24-78) of which 4 were classified as young adults. A total of 75% received transplantation in the state where they lived, 92% were White, and 14 patients identified as male. Interview lengths ranged from 45 to 135 minutes, with an average duration of 77 minutes.

According to McAndrew, further studies could be expanded to a greater number of hematologic indications and include a greater degree of racial diversity.

“HSCT recipients continue to struggle with physical and mental health challenges years after transplant,” McAndrew concluded in the presentation with coauthors. “Research/practice priorities include developing and testing meaning-focused and peer-based psychosocial interventions and extending holistic, supportive care to families to address gaps in survivorship care.”

References

McAndrew NS, Patterson S, Mohanraj L, Awoyinka I, Knight J. A qualitative study of life after hematopoietic stem cell transplant: the need for continued psychosocial support. Presented at the 22nd Annual American Psychosocial Oncology Society (APOS) Conference; Pittsburgh, PA, March 5-7, 2025