Transplant Research and Risk Management (Apr 2019)
Effect of pretransplant depression on neutrophil recovery following hematopoietic stem cell transplantation
Abstract
Maria Tavakoli-Ardakani,1,2 Narges Beyraghi,3 Mahtabalsadat Mirjalili,4 Ehsan Mirzaei,4 Maryam Mehrpooya51Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2Pharmaceutical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3Neurofunctional and Neurology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 4Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; 5Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, IranPurpose: Pre-transplantation depression is known to exert negative effects on clinical outcomes after hematopoietic stem cell transplantation (HSCT). Accumulating evidence shows a bidirectional association between inflammation and depression. Systemic inflammation can affect clinical outcomes after transplantation, such as time to engraftment. This study evaluated the effect of pre-transplantation depression and serum level of pro-inflammatory and anti-inflammatory cytokines on clinical outcomes such as neutrophil recovery time and mortality in patients undergoing HSCT.Patients and methods: In this cross-sectional study, we recruited 73 patients who were autologous or allogeneic HSCT candidates. Hospital Anxiety and Depression Scale questionnaire was used to assess depression in the first 2 days after their hospital admission. Serum levels of IL-10, IL-6, and hs-CRP were measured at the same time. Neutrophil engraftment time, length of hospitalization, rate of mortality, relapses, readmissions, and occurrence of major complications following HSCT in a 1-year follow-up period were recorded as comparative outcomes.Results: Thirty-five patients with depression and 38 patients without depression participated in the study. Among the related outcomes, time of engraftment (P=0.020) and mortality rate (P=0.059) were statistically different between the two groups. Depressed patients had longer neutrophil engraftment time and higher mortality rate 1 year following transplantation (14.14±3.95 days and 31.43%) in comparison to non-depressed patients (12.21±2.81 days and 13.16%). Depressed patients showed significantly higher serum levels of IL-6 and IL-6-to-IL-10 ratio compared to non-depressed participants (P<0.001 and P=0.004).Conclusion: According to the results, pre-transplant depression can negatively impact neutrophil recovery time and mortality rate following HSCT. Higher levels of inflammatory factors in depressed patients might be one of the mechanisms that negatively affect clinical outcomes after HSCT.Keywords: depression, inflammation, hematopoietic stem cell transplantation, neutrophil recovery time
