Early Patient-Reported Outcomes and Graft-Versus-Host Disease as Indicators of Long-Term Quality of Life and Fatigue After Allogeneic Hematopoietic Stem Cell Transplantation: A 24-Month Prospective Study

Background/Objectives: Long-term recovery after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is heterogeneous, and early patient-reported outcomes (PROs) may provide clinically relevant information about later survivorship. We examined whether quality of life (QoL), fatigue, and early graft-versus-host disease (GVHD) were associated with PROs at 24 months after allo-HSCT. Methods: Adult allo-HSCT recipients were prospectively followed at six predefined timepoints up to 24 months. The primary early landmark was 6 months (T3), and the primary long-term outcome was 24-month (T6) QoL assessed using the Functional Assessment of Cancer Therapy—Bone Marrow Transplant (FACT-BMT). Fatigue was assessed using the Brief Fatigue Inventory (BFI) and Functional Assessment of Chronic Illness Therapy—Fatigue (FACIT-F). Associations were examined using parsimonious regression models including early GVHD. Results: Twenty-eight participants had PRO data at both T3 and T6. Higher FACT-BMT at T3 was associated with higher FACT-BMT at T6 after adjustment for early GVHD (B = 1.077, 95% CI 1.019–1.135, p < 0.001). Early GVHD remained associated with lower T6 FACT-BMT (B = −6.133, 95% CI −9.373 to −2.893, p < 0.001). Higher BFI and lower FACIT-F at T3 were associated with poorer T6 QoL, while 6-month fatigue was also associated with corresponding 24-month fatigue outcomes. Among patients with GVHD, non-responders had less favorable 24-month fatigue outcomes than responders. Conclusions: PROs at 6 months were strongly associated with 24-month QoL and fatigue. The 6-month assessment may represent a clinically informative survivorship landmark, although larger multicenter studies are needed to confirm these associations.