Fatigue and quality of life in the early phase after allogeneic hematopoietic stem cell transplantation: dynamics and the impact of graft-versus-host disease

PURPOSE: Fatigue and impaired quality of life are common after allogeneic hematopoietic stem cell transplantation (allo-HSCT), particularly in patients who develop graft-versus-host disease (GVHD). This study assessed the dynamics of fatigue and quality of life during the first 6 months after allo-HSCT and evaluated their association with GVHD status and response to GVHD treatment. METHODS: This prospective study represents an early-phase analysis from a larger longitudinal project evaluating patient-reported outcomes after allo-HSCT across six predefined assessment points up to 24 months. The primary complete-case analysis included 28 adult patients with complete assessments at the first three timepoints: within 24 h after transplantation (T1), at 1 month (T2), and at 6 months (T3). Fatigue was assessed using FACIT-F and BFI, and quality of life using FACT-BMT. Patients were grouped according to GVHD status and response to GVHD treatment. Longitudinal analyses were performed using linear mixed-effects models. Additional sensitivity analyses were conducted using all available early-phase PRO data. RESULTS: Fourteen patients developed GVHD during early follow-up. Quality of life improved and fatigue decreased over time (all p < 0.001). Patients who developed GVHD reported consistently worse outcomes, with lower FACT-BMT and higher fatigue across the first 6 months after transplantation (all p < 0.001), without significant time-by-GVHD interactions. In exploratory analyses within the GVHD subgroup, responders had better quality of life and lower fatigue than non-responders (FACT-BMT: p = 0.016; BFI: p < 0.001; FACIT-F: p = 0.017). Fatigue was strongly associated with quality of life (BFI: r = -0.813; FACIT-F: r = 0.857; both p < 0.001) and remained an independent correlate of FACT-BMT in multivariable models. CONCLUSIONS: In this early-phase complete-case cohort, development of GVHD during early follow-up was associated with persistently worse quality of life and higher fatigue during the first 6 months after allo-HSCT. Fatigue was strongly associated with patient-reported outcomes and may represent a clinically relevant, potentially modifiable target for supportive care. These findings should be interpreted in light of the small sample size, complete-case design, follow-up-defined GVHD classification, and potential selection bias.