Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Quality of life following hematopoietic cell transplantation

Robert S Negrin, MD
Section Editor
Nelson J Chao, MD
Deputy Editor
Alan G Rosmarin, MD


Although difficult to define precisely, quality of life (QOL) has an inherent meaning to most people. It is comprised of broad concepts that affect global life satisfaction, including good health, adequate housing, employment, personal and family safety, interrelationships, education, and leisure pursuits. For matters related to health care, the term QOL has been applied specifically to those life concerns that are most affected by health or illness. Patients contemplating hematopoietic cell transplantation (HCT), like any other major medical intervention, often question what the quality of their lives will be following the procedure. The success of HCT has resulted in a large number of patients becoming long term survivors, bringing the issue of QOL to the forefront [1-4].

Clearly, the long-term effects of HCT, and the attendant QOL of long-term survivors, are due to the complete treatment program (table 1), not just to the transplant itself. (See "Preparative regimens for hematopoietic cell transplantation" and "Hematopoietic support after hematopoietic cell transplantation" and "Treatment of chronic graft-versus-host disease".)

This topic review will discuss the general issue of QOL in HCT donors, survivors of HCT, and their caregivers [5]. Complication- or disease-specific long-term issues, such as the development of malignancy following HCT and care of the long term survivor, are discussed separately. (See "The approach to hematopoietic cell transplantation survivorship" and "Malignancy after hematopoietic cell transplantation" and "Thalassemia: Management after hematopoietic cell transplantation" and "Hematopoietic cell transplantation for aplastic anemia in adults", section on 'Late malignancy' and "Hematopoietic cell transplantation for aplastic anemia in adults", section on 'Survival and quality of life'.)

A general review of QOL, which includes its assessment in patients with medical illness and emphasizing malignant disease, is presented separately. (See "Evaluation of health-related quality of life (HRQL) in patients with a serious life-threatening illness".)


QOL among patients who have undergone autologous HCT is generally excellent. The lack of graft-versus-host disease (GVHD) in this setting and the observation that the major cause of morbidity and mortality beyond the first several months following the transplant is relapse of the underlying disease, means that the majority of long-term survivors enjoy an outstanding QOL.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Sep 26, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Lee SJ, Joffe S, Kim HT, et al. Physicians' attitudes about quality-of-life issues in hematopoietic stem cell transplantation. Blood 2004; 104:2194.
  2. Pidala J, Anasetti C, Jim H. Quality of life after allogeneic hematopoietic cell transplantation. Blood 2009; 114:7.
  3. Wong FL, Francisco L, Togawa K, et al. Long-term recovery after hematopoietic cell transplantation: predictors of quality-of-life concerns. Blood 2010; 115:2508.
  4. Gooley TA, Chien JW, Pergam SA, et al. Reduced mortality after allogeneic hematopoietic-cell transplantation. N Engl J Med 2010; 363:2091.
  5. Pidala J, Anasetti C, Jim H. Health-related quality of life following haematopoietic cell transplantation: patient education, evaluation and intervention. Br J Haematol 2010; 148:373.
  6. Chao NJ, Tierney DK, Bloom JR, et al. Dynamic assessment of quality of life after autologous bone marrow transplantation. Blood 1992; 80:825.
  7. McQuellon RP, Craven B, Russell GB, et al. Quality of life in breast cancer patients before and after autologous bone marrow transplantation. Bone Marrow Transplant 1996; 18:579.
  8. Winer EP, Lindley C, Hardee M, et al. Quality of life in patients surviving at least 12 months following high dose chemotherapy with autologous bone marrow support. Psychooncology 1999; 8:167.
  9. Jacobsen PB, Widows MR, Hann DM, et al. Posttraumatic stress disorder symptoms after bone marrow transplantation for breast cancer. Psychosom Med 1998; 60:366.
  10. Clarke SA, Eiser C, Skinner R. Health-related quality of life in survivors of BMT for paediatric malignancy: a systematic review of the literature. Bone Marrow Transplant 2008; 42:73.
  11. Tauchmanovà L, Selleri C, De Rosa G, et al. Endocrine disorders during the first year after autologous stem-cell transplant. Am J Med 2005; 118:664.
  12. Syrjala KL, Dikmen S, Langer SL, et al. Neuropsychologic changes from before transplantation to 1 year in patients receiving myeloablative allogeneic hematopoietic cell transplant. Blood 2004; 104:3386.
  13. Fann JR, Alfano CM, Roth-Roemer S, et al. Impact of delirium on cognition, distress, and health-related quality of life after hematopoietic stem-cell transplantation. J Clin Oncol 2007; 25:1223.
  14. Andrykowski MA, Altmaier EM, Barnett RL, et al. Cognitive dysfunction in adult survivors of allogeneic marrow transplantation: relationship to dose of total body irradiation. Bone Marrow Transplant 1990; 6:269.
  15. Harder H, Cornelissen JJ, Van Gool AR, et al. Cognitive functioning and quality of life in long-term adult survivors of bone marrow transplantation. Cancer 2002; 95:183.
  16. Andrykowski MA, Bruehl S, Brady MJ, Henslee-Downey PJ. Physical and psychosocial status of adults one-year after bone marrow transplantation: a prospective study. Bone Marrow Transplant 1995; 15:837.
  17. Wolcott DL, Wellisch DK, Fawzy FI, Landsverk J. Adaptation of adult bone marrow transplant recipient long-term survivors. Transplantation 1986; 41:478.
  18. Wingard JR, Curbow B, Baker F, Piantadosi S. Health, functional status, and employment of adult survivors of bone marrow transplantation. Ann Intern Med 1991; 114:113.
  19. Schmidt GM, Niland JC, Forman SJ, et al. Extended follow-up in 212 long-term allogeneic bone marrow transplant survivors. Issues of quality of life. Transplantation 1993; 55:551.
  20. Socié G, Mary JY, Esperou H, et al. Health and functional status of adult recipients 1 year after allogeneic haematopoietic stem cell transplantation. Br J Haematol 2001; 113:194.
  21. Kiss TL, Abdolell M, Jamal N, et al. Long-term medical outcomes and quality-of-life assessment of patients with chronic myeloid leukemia followed at least 10 years after allogeneic bone marrow transplantation. J Clin Oncol 2002; 20:2334.
  22. Bush NE, Haberman M, Donaldson G, Sullivan KM. Quality of life of 125 adults surviving 6-18 years after bone marrow transplantation. Soc Sci Med 1995; 40:479.
  23. Baker F, Wingard JR, Curbow B, et al. Quality of life of bone marrow transplant long-term survivors. Bone Marrow Transplant 1994; 13:589.
  24. Altmaier EM, Gingrich RD, Fyfe MA. Two-year adjustment of bone marrow transplant survivors. Bone Marrow Transplant 1991; 7:311.
  25. Syrjala KL, Chapko MK, Vitaliano PP, et al. Recovery after allogeneic marrow transplantation: prospective study of predictors of long-term physical and psychosocial functioning. Bone Marrow Transplant 1993; 11:319.
  26. Duell T, van Lint MT, Ljungman P, et al. Health and functional status of long-term survivors of bone marrow transplantation. EBMT Working Party on Late Effects and EULEP Study Group on Late Effects. European Group for Blood and Marrow Transplantation. Ann Intern Med 1997; 126:184.
  27. Bhatia S, Francisco L, Carter A, et al. Late mortality after allogeneic hematopoietic cell transplantation and functional status of long-term survivors: report from the Bone Marrow Transplant Survivor Study. Blood 2007; 110:3784.
  28. Chiodi S, Spinelli S, Ravera G, et al. Quality of life in 244 recipients of allogeneic bone marrow transplantation. Br J Haematol 2000; 110:614.
  29. Wiskemann J, Dreger P, Schwerdtfeger R, et al. Effects of a partly self-administered exercise program before, during, and after allogeneic stem cell transplantation. Blood 2011; 117:2604.
  30. Baker KS, Gurney JG, Ness KK, et al. Late effects in survivors of chronic myeloid leukemia treated with hematopoietic cell transplantation: results from the Bone Marrow Transplant Survivor Study. Blood 2004; 104:1898.
  31. Mitchell SA, Leidy NK, Mooney KH, et al. Determinants of functional performance in long-term survivors of allogeneic hematopoietic stem cell transplantation with chronic graft-versus-host disease (cGVHD). Bone Marrow Transplant 2010; 45:762.
  32. Harris BA, Berger AM, Mitchell SA, et al. Spiritual well-being in long-term survivors with chronic graft-versus-host disease after hematopoietic stem cell transplantation. J Support Oncol 2010; 8:119.
  33. Fraser CJ, Bhatia S, Ness K, et al. Impact of chronic graft-versus-host disease on the health status of hematopoietic cell transplantation survivors: a report from the Bone Marrow Transplant Survivor Study. Blood 2006; 108:2867.
  34. Marks DI, Gale DJ, Vedhara K, Bird JM. A quality of life study in 20 adult long-term survivors of unrelated donor bone marrow transplantation. Bone Marrow Transplant 1999; 24:191.
  35. Molassiotis A, Morris PJ. Quality of life in patients with chronic myeloid leukemia after unrelated donor bone marrow transplantation. Cancer Nurs 1999; 22:340.
  36. Barrera M, Atenafu E. Cognitive, educational, psychosocial adjustment and quality of life of children who survive hematopoietic SCT and their siblings. Bone Marrow Transplant 2008; 42:15.
  37. Badell I, Igual L, Gomez P, et al. Quality of life in young adults having received a BMT during childhood: a GETMON study. Grupo Español de Trasplante de Médula Osea en el Niño. Bone Marrow Transplant 1998; 21 Suppl 2:S68.
  38. Barrera M, Atenafu E, Pinto J. Behavioral, social, and educational outcomes after pediatric stem cell transplantation and related factors. Cancer 2009; 115:880.
  39. Sanders JE, Hoffmeister PA, Storer BE, et al. The quality of life of adult survivors of childhood hematopoietic cell transplant. Bone Marrow Transplant 2010; 45:746.
  40. Andrykowski MA, Greiner CB, Altmaier EM, et al. Quality of life following bone marrow transplantation: findings from a multicentre study. Br J Cancer 1995; 71:1322.
  41. Lee SJ, Fairclough D, Parsons SK, et al. Recovery after stem-cell transplantation for hematologic diseases. J Clin Oncol 2001; 19:242.
  42. Vellenga E, van Agthoven M, Croockewit AJ, et al. Autologous peripheral blood stem cell transplantation in patients with relapsed lymphoma results in accelerated haematopoietic reconstitution, improved quality of life and cost reduction compared with bone marrow transplantation: the Hovon 22 study. Br J Haematol 2001; 114:319.
  43. van Agthoven M, Vellenga E, Fibbe WE, et al. Cost analysis and quality of life assessment comparing patients undergoing autologous peripheral blood stem cell transplantation or autologous bone marrow transplantation for refractory or relapsed non-Hodgkin's lymphoma or Hodgkin's disease. a prospective randomised trial. Eur J Cancer 2001; 37:1781.
  44. Gallardo D, de la Cámara R, Nieto JB, et al. Is mobilized peripheral blood comparable with bone marrow as a source of hematopoietic stem cells for allogeneic transplantation from HLA-identical sibling donors? A case-control study. Haematologica 2009; 94:1282.
  45. Molassiotis A, van den Akker OB, Milligan DW, et al. Quality of life in long-term survivors of marrow transplantation: comparison with a matched group receiving maintenance chemotherapy. Bone Marrow Transplant 1996; 17:249.
  46. Watson M, Wheatley K, Harrison GA, et al. Severe adverse impact on sexual functioning and fertility of bone marrow transplantation, either allogeneic or autologous, compared with consolidation chemotherapy alone: analysis of the MRC AML 10 trial. Cancer 1999; 86:1231.
  47. Watson M, Buck G, Wheatley K, et al. Adverse impact of bone marrow transplantation on quality of life in acute myeloid leukaemia patients; analysis of the UK Medical Research Council AML 10 Trial. Eur J Cancer 2004; 40:971.
  48. Syrjala KL, Roth-Roemer SL, Abrams JR, et al. Prevalence and predictors of sexual dysfunction in long-term survivors of marrow transplantation. J Clin Oncol 1998; 16:3148.
  49. Syrjala KL, Kurland BF, Abrams JR, et al. Sexual function changes during the 5 years after high-dose treatment and hematopoietic cell transplantation for malignancy, with case-matched controls at 5 years. Blood 2008; 111:989.
  50. McQuellon RP, Russell GB, Rambo TD, et al. Quality of life and psychological distress of bone marrow transplant recipients: the 'time trajectory' to recovery over the first year. Bone Marrow Transplant 1998; 21:477.
  51. Cassileth BR, Vickers AJ, Magill LA. Music therapy for mood disturbance during hospitalization for autologous stem cell transplantation: a randomized controlled trial. Cancer 2003; 98:2723.
  52. Loberiza FR Jr, Rizzo JD, Bredeson CN, et al. Association of depressive syndrome and early deaths among patients after stem-cell transplantation for malignant diseases. J Clin Oncol 2002; 20:2118.
  53. Prieto JM, Atala J, Blanch J, et al. Role of depression as a predictor of mortality among cancer patients after stem-cell transplantation. J Clin Oncol 2005; 23:6063.
  54. Barrera M, Atenafu E, Hancock K. Longitudinal health-related quality of life outcomes and related factors after pediatric SCT. Bone Marrow Transplant 2009; 44:249.
  55. Bush NE, Donaldson GW, Haberman MH, et al. Conditional and unconditional estimation of multidimensional quality of life after hematopoietic stem cell transplantation: a longitudinal follow-up of 415 patients. Biol Blood Marrow Transplant 2000; 6:576.
  56. Kopp M, Schweigkofler H, Holzner B, et al. Time after bone marrow transplantation as an important variable for quality of life: results of a cross-sectional investigation using two different instruments for quality-of-life assessment. Ann Hematol 1998; 77:27.
  57. Broers S, Kaptein AA, Le Cessie S, et al. Psychological functioning and quality of life following bone marrow transplantation: a 3-year follow-up study. J Psychosom Res 2000; 48:11.
  58. Deeg HJ, Leisenring W, Storb R, et al. Long-term outcome after marrow transplantation for severe aplastic anemia. Blood 1998; 91:3637.
  59. Syrjala KL, Langer SL, Abrams JR, et al. Recovery and long-term function after hematopoietic cell transplantation for leukemia or lymphoma. JAMA 2004; 291:2335.
  60. Andrykowski MA, Bishop MM, Hahn EA, et al. Long-term health-related quality of life, growth, and spiritual well-being after hematopoietic stem-cell transplantation. J Clin Oncol 2005; 23:599.
  61. Syrjala KL, Langer SL, Abrams JR, et al. Late effects of hematopoietic cell transplantation among 10-year adult survivors compared with case-matched controls. J Clin Oncol 2005; 23:6596.
  62. Siddiq S, Pamphilon D, Brunskill S, et al. Bone marrow harvest versus peripheral stem cell collection for haemopoietic stem cell donation in healthy donors. Cochrane Database Syst Rev 2009; :CD006406.
  63. Pamphilon D, Siddiq S, Brunskill S, et al. Stem cell donation--what advice can be given to the donor? Br J Haematol 2009; 147:71.
  64. Nishimori M, Yamada Y, Hoshi K, et al. Health-related quality of life of unrelated bone marrow donors in Japan. Blood 2002; 99:1995.
  65. Pulsipher MA, Chitphakdithai P, Miller JP, et al. Adverse events among 2408 unrelated donors of peripheral blood stem cells: results of a prospective trial from the National Marrow Donor Program. Blood 2009; 113:3604.
  66. Hölig K, Kramer M, Kroschinsky F, et al. Safety and efficacy of hematopoietic stem cell collection from mobilized peripheral blood in unrelated volunteers: 12 years of single-center experience in 3928 donors. Blood 2009; 114:3757.
  67. Sevilla J, González-Vicent M, Lassaletta A, et al. Peripheral blood progenitor cell collection adverse events for childhood allogeneic donors: variables related to the collection and safety profile. Br J Haematol 2009; 144:909.
  68. Bishop MM, Beaumont JL, Hahn EA, et al. Late effects of cancer and hematopoietic stem-cell transplantation on spouses or partners compared with survivors and survivor-matched controls. J Clin Oncol 2007; 25:1403.