Long-term Effect of Hematopoietic Stem Cell Transplantation on the Quality of Life of Patients with ?-thalassemia Major in Guangxi, China - A Cross-sectional Study

Objective: The purpose of our study was to compare the quality of life (QOL) of patients with hematopoietic stem cell transplantation (HSCT) for more than 2 years for ss -thalassemia major (ss-TM) with that of ss-TM patients with conventional therapy (blood infusion and iron chelation) and that of the general population. Methods: This was a cross-sectional comparative study on the QOL of 225 ss-TM patients treated with blood transfusion and iron chelation therapy, 133 ss-TM patients who had undergone HSCT or 270 ageand sex-matched healthy individuals from Guangxi, China. Child-self and parent-proxy reports of the PedsQL 4.0 Generic Core Scales were used to prospectively evaluate QOL. Results: The incidence of acute GVHD was 14.3% (grade III-IV in 4.5% of patients), and that of chronic GVHD was 3.8%. This was lower than that of previous studies since the inclusion of anti-thymocyte globulin (ATG). Patients who underwent transplantation from a voluntary donor had higher QOL scores and lower rates of acute GVHD, chronic GVHD and comorbidities than those receiving stem cell sources from an HLA mismatched related donor (haploidentical donor). Transplants with PBSCs or UCBT, PBSCT+BMT, BMT, or BMT+UCBT as stem cell sources did not have any impact on QOL. The QOL of ss-TM patients was very similar to that of the general population. More complications (P<0.001), shorter post-transplantation time (P<0.001), and older age at HSCT (P=0.01) were associated with poorer child QOL (P=0.020). Additional analyses investigating QOL of ss- TM patients receiving conventional treatment with ss-TM revealed poorer outcomes than the cohort of transplanted patients. Conclusion: ss-TM patients can be cured by HSCT and regain QOL as good as that of the general population. ss-TM patients are suggested to undergo HSCT as soon as possible to avoid complications related to iron overload and blood infusion.