The effect of pre-transplant distress on immune reconstitution among adult autologous hematopoietic cell transplantation patients

Brain Behav Immun. 2013 Mar;30 Suppl(Suppl):S142-8. doi: 10.1016/j.bbi.2012.07.020. Epub 2012 Aug 13.

Abstract

Myeloablative hematopoietic cell transplantation (HCT) is a common treatment for hematological malignancy. Delayed immune reconstitution following HCT is a major impediment to recovery with patients being most vulnerable during the first month after transplant. HCT is a highly stressful process. Because psychological distress has been associated with down regulation of immune function we examined the effect of pre-transplant distress on white blood cell (WBC) count among 70 adult autologous HCT patients during the first 3 weeks after transplant. The participants were on average 38 years old; 93% Caucasian, non-Hispanic and 55% male. Pre-transplant distress was measured 2-14 days before admission using the Cancer and Treatment Distress (CTXD) scale, and the Symptom Checklist-90-R (SCL-90-R) anxiety and depression subscales. WBC count was measured during initial immune recovery on days 5 through 22 post-transplant. Linear mixed model regression analyses controlling for gender and treatment-related variables revealed a significant effect of the mean pre-transplant SCL Anxiety-Depression score on WBC recovery. We found no significant effect of pre-transplant CTXD on WBC recovery. In general, higher levels of pre-treatment anxiety and depression were associated with slower WBC recovery. Psychological modulation of WBC recovery during HCT suggests a unique mechanism by which psychological distress can exert influence over the immune system. Given that WBC recovery is essential to survival for HCT patients, these data provide a rationale for treating anxiety and depression in HCT patients.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Anxiety / immunology
  • Anxiety / psychology
  • Depression / immunology
  • Depression / psychology
  • Female
  • Hematologic Neoplasms / immunology
  • Hematologic Neoplasms / psychology
  • Hematologic Neoplasms / therapy*
  • Hematopoietic Stem Cell Transplantation / psychology*
  • Humans
  • Leukocyte Count
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Prospective Studies
  • Psychiatric Status Rating Scales
  • Self Report
  • Sex Factors
  • Stress, Psychological / immunology*
  • Stress, Psychological / psychology
  • Treatment Outcome