Patients with leukemia or lymphoma who survive hematopoietic cell transplantation can expect full physical and emotional recovery to take 3 to 5 years, according to an article in the May 19th issue of The Journal of the American Medical Association.

Before the current research, the rate and predictors of physical and emotional recovery after hematopoietic cell transplantation had not been well defined in long-term studies. According to the study authors, improved understanding of recovery could facilitate more accurate informed consent, permit better planning by patients, families, and medical teams, and enable the design of interventions to improve functional recovery.

Karen L. Syrjala, PhD, and her American colleagues conducted examined recovery of physical and mental health and return to work after cell transplantation for treatment of leukemia or lymphoma. Patient function was assessed from pre-transplantation to 5-year follow-up for 319 adults who had myeloablative transplantation for treatment of leukemia or lymphoma. Of the 99 long-term survivors without recurrent malignancy, 94 completed 5-year follow-up.

The researchers found that physical recovery occurred earlier than psychological or work recovery. Only 19 percent of patients had recovered on all outcomes at 1 year. The proportion without major limitations increased to 63 percent by 5 years.

"Results of this prospective longitudinal study show that recovery after hematopoietic cell transplantation occurs gradually over 1 to 5 years as measured by improvement in physical function, return to work, depression, and treatment-related distress. Given adequate time, 84 percent of survivors returned to full-time work. At some point during treatment or recovery, 22 percent of the patients had symptoms consistent with clinical depression while an additional 31 percent had mild depressive symptoms. Higher levels of depression, lower levels of physical function, and less satisfaction with social support before transplantation increased the risk of impaired physical and emotional recovery after the transplantation. Women had increased risk for depression, treatment-related distress, and delayed return to full-time work. Conversely, previous experience with chemotherapy or radiation therapy before beginning hematopoietic cell transplantation seemed to facilitate recovery from the psychological aspects of this intensive treatment," the authors wrote.

"These results are both encouraging and cautionary. Patients, families, and medical teams depend on accurate recovery data when planning for pos-transplant needs. Expectations that contradict actual experience cause stress for survivors and potential conflicts with family, work, and the medical team. To facilitate realistic planning, clinicians and patients should understand that full recovery requires more than a year for most survivors. Patients at risk for delayed recovery can be identified before transplantation. Rehabilitation programs, similar to those that have accelerated recovery for cardiac patients, might improve the physical and psychological health of hematopoietic cell transplantation recipients and other patients who have survived after curative treatment for cancer," the researchers concluded.