Context Hematopoietic cell transplantation (HCT) is an effective and widely
used treatment for hematologic malignancies. The rate and predictors of physical
and emotional recovery after HCT have not been adequately defined in prospective
Objective To examine the course of recovery and return to work after HCT.
Design, Setting, and Patients Prospective, longitudinal cohort study at a US academic center specializing
in HCT. Function was assessed from pretransplantation to 5-year follow-up
for 319 adults who had myeloablative HCT for treatment of leukemia or lymphoma
and spoke English. Of the 99 long-term survivors who had no recurrent malignancy,
94 completed 5-year follow-up.
Main Outcome Measures Physical limitations, return to work, depression, and distress related
to treatment or disease were evaluated before transplantation, at 90 days,
and at 1, 3, and 5 years after HCT.
Results Physical recovery occurred earlier than psychological or work recovery.
Only 21 patients (19%) recovered on all outcomes at 1 year. The proportion
without major limitations increased to 63% (n = 57) by 5 years. Among survivors
without recurrent malignancy, 84% (n = 74) returned to full-time work by 5
years. Patients with slower physical recovery had higher medical risk and
were more depressed before HCT (P≤.001). Patients
with chronic graft-vs-host disease (P = .01), with
less social support before HCT (P = .001), and women
(P<.001) were more depressed after transplantation.
Transplant-related distress was slower to recover for allogeneic transplant
recipients and those with less social support before HCT (P≤.01). Patients who had more experience with cancer treatment before
beginning HCT had more rapid recovery from depression (P = .04) and treatment-related distress (P =
Conclusions Full recovery after HCT is a 3- to 5-year process. Recovery might be
accelerated by more effective interventions to increase work-related capabilities,
improve social support, and manage depression.