Biobehavioral Research and Hematopoietic Stem Cell Transplantation: Expert Review from the Biobehavioral Research Special Interest Group of the American Society for Transplantation and Cellular Therapy

Abstract

Hematopoietic stem cell transplantation (HCT) is a potentially curative treatment for many hematologic conditions. Despite advances in conditioning and supportive measures, however, there remain significant comorbidities that threaten survivorship. Adverse effects of stress-related biobehavioral processes-defined here as the interactions of behavioral, psychological, and socioenvironmental factors with biology-impact immune recovery and function and are particularly salient in the HCT context, given the importance of immune reconstitution for improved survivorship. However, biobehavioral processes have been underinvestigated in this vulnerable group compared with other cancer populations. Here the Biobehavioral Research Special Interest Group (SIG) of the American Society for Transplantation and Cellular Therapy provides an expert review to inform research directions explicating the biological correlates of behavioral symptoms and evaluate the impact of these on HCT outcomes. The goal of this expert review is to provide a foundation for advancing science that effectively integrates behavioral and biological processes to optimize quality of life and improve clinical outcomes for HCT recipients.

Keywords: Biobehavioral; hematopoietic cell transplantation; outcomes; stress; survivorship.

Copyright © 2021 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1.

Biobehavioral model illustrating bidirectional relationships between biological and behavioral factors and effects of relevance to HCT throughout the trajectory from pretransplantation to long-term survivorship. It is intended not to be comprehensive but rather to provide a conceptual framework for applying biobehavioral science to the HCT setting. In brief, individual differences in sociodemographic, health, and psychosocial factors, including health practices (eg, substance use, medication adherence), as well as disease- and HCT-related factors, affect biobehavioral mechanisms and relationships explicated in this article. The article is organized by the behavioral symptoms listed here, which are among the most common and distressing for HCT recipients. Biological processes affected by HCT, including inflammation and disrupted circadian rhythms, can alter central nervous system pathways that evoke behavioral symptoms highlighted here. Psychosocial stressors and stress-related behavioral factors activate the hypothalamic-pituitary-adrenal and SNS axes as well as associated proteomic, genomic, and metabolomic pathways (elucidated in new research as ’omics technologies). The secreted products of these pathways (eg, glucocorticoids, catecholamines) and direct sympathetic innervation of the bone marrow microenvironment can modulate cell recovery following HCT and promote (or moderate) an inflammatory environment that predisposes the HCT recipient to GVHD and other HCT-associated complications. These physiologic processes have the potential to influence clinical events following HCT, including the development of infections, modulation of the activity of effector cells on residual disease, and the occurrence of acute and chronic GVHD, thereby affecting QOL and the risk for disease progression or relapse, late effects, and survival. PFS, progression-free survival; OS, overall survival.