To investigate the quality of life and its impact factors in patients with chronic graft versus host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Patients who developed cGVHD following allo-HSCT treatment at the Bone Marrow Transplantation Center, the First Affiliated Hospital of Zhejiang University, School of Medicine from June 2016 to June 2020 were enrolled. The investigating periods was from the initial diagnosis of cGVHD to 9 months after diagnosis. We collected the characteristics of patients at the time of diagnosis of cGVHD and 3, 6, 9 months after diagnosis. The functional assessment of cancer treatment-bone marrow transplant (FACT-BMT V4.0) was measured at the time of diagnosis of cGVHD and 3, 6, 9 months after diagnosis. Non-normal distribution continuous variables were analyzed using Kruskal-Wallis H test. Categorical covariates were analyzed using the Chi-square test. Univariate analysis was used to analyze the impact factors of quality of life of patients at 3 months after diagnosis of cGVHD. Factors with P<0.05 in univariate analysis and age of patients were selected for multiple liner regression analysis. P<0.05 was considered statistically significant.

A total of 247 patients with cGVHD after allo-HSCT were enrolled, including 111 patients with mild cGVHD, 104 patients with moderate cGVHD, and 32 patients with severe cGVHD. There were significant differences in the proportion of primary diseases and transplantation periods among the 3 groups (χ²=15.446 and 44.456, all P<0.05). There were significant differences in physical status, social/family status, emotional status, functional status, stem cell transplantation module scores and FACT-BMT V4.0 total scores among mild, moderate and severe cGVHD groups (H=41.184, 16.277, 22.695, 27.014, 60.112 and 64.645, all P<0.05). The median follow-up time of 247 patients with cGVHD after allo-HSCT was 948 (246, 1 867) d at the last follow-up. And 68.4% (169/247) of cGVHD patients achieved complete response (CR)/partial response (PR) after systematic treatment. The total score of FACT-BMT V4.0 in patients got CR/PR was 152 (111, 183), 124 (95, 154), 129 (100, 157) and 152 (120, 182) at the time of diagnosis of cGVHD and 3, 6 and 9 months after diagnosis, respectively. There was significant difference of FACT-BMT total score at different time points of cGVHD (H=344.113, P<0.05). Univariate and multiple linear regression analysis showed that cGVHD severity and glucocorticoid resistance were independent risk factors for the quality of life of patients with cGVHD after allo-HSCT at 3 months after diagnosis (all P<0.05).

FACT-BMT V4.0 has a good application prospect in allo-HSCT population. cGVHD severely limits the quality of life of patients following allo-HSCT. Besides, quality of life was closely related to the severity of cGVHD and glucocorticoids resistance. The patients who achieved CR/PR after treatment of cGVHD showed a dynamic upward trends of FACT-BMT total score.