Discussion
appetite loss, GVHD
APPETITE LOSS, GVHD, COMPLICATIONS, COMPLICATION
Our findings suggest that both the HCT-CI- and the EBMT scores at baseline were prognostic for 1-year OS and for 1-year NRM. None of the PROs from the EORTC QLQ C30 questionnaire remained significant in the multivariable analysis on 1-year OS. Moreover, the analyses suggested that only appetite loss, living alone, and stem cell source could predict 1-year NRM, and appetite loss could be the only PRO with an independent prognostic value.The HCT-CI and the EBMT risk scores as predictors of outcomes in allo-HSCT recipients have been examined in both prospective and retrospective multi-center studies [Interestingly, our analysis suggest that both stem cell source and living alone could predict 1-year NRM, but not 1-year OS, in the multivariable analyses. This finding can be explained by the causes of treatment-related morbidity and mortality, which is the main complication of allo-HSCT. For example, it is commonly reported that patients who receive stem cells from peripheral blood compared to stem cells from the bone marrow have an increased risk of GVHD [With regard to living alone as a suggested predictor for 1-year NRM, it can be assumed that for transplanted patients with one or more complications, survival may depend on whether the patients have a care person [Somewhat surprisingly, our analysis suggested that appetite loss could be associated with 1-year NRM, so that a higher appetite loss would indicate a lower 1-year NRM. Most previous research has reached the opposite conclusion [In contrast to previous studies, we did not find any significant predictors of either 1-year OS or 1-year NRM among the tested PROs derived from the QLQ C30 questionnaire (except for appetite loss as discussed above). This is in contrast with Hamilton and collaborators’ extensive study on PROs being predictive for survival, relapse, and NRM after allo-HSCT, where they found that physical well-being was prognostic for overall mortality [Our study had some limitations. The exploratory nature of our analysis should be considered when interpreting the results, and the sample size was not large enough to conduct specific sub-analyses. Also, we studied a rather homogeneous patient population that may limit the generalizability of our findings. A strength of our study is the high-quality data obtained in the context of a robust RCT setting in a well-defined patient group.In conclusion, whereas our analysis suggest that the two common risk tools (HCT-CI and EBMT risk scores) were predictive for 1-year OS and 1-year NRM, baseline PROs data had little or no associations with these outcomes in this specific setting.