Studies have shown that patients with strong social networks (family, friends, and work associates) often show improved mental and physical health outcomes. This holds true for individuals recovering from hematopoietic stem cell transplantation (HCT). However, while recent analyses have found a significant relationship between patient-reported well-being and overall survival following HCT, there is a gap in our understanding of the biological mechanisms responsible for this relationship. A multi-site study, published in Blood Advances, aimed to close this gap by taking a closer look at an alarm marker called the conserved transcriptional response to adversity (CTRA), which is associated with cancer progression, cardiovascular disease, viral infections, chronic fatigue, and depression.
鈥淲e discovered that significantly elevated levels of CTRA were observed in patients who reported social isolation and resulting loneliness, while patients with stronger social networks showed fewer traces of CTRA,鈥� said Jennifer Knight, MD, MS, FACLP, associate professor of psychiatry and behavioral medicine. 鈥淏ecause the CTRA molecular profile is easily measured and modifiable, targeting the psychosocial-CTRA pathway through behavioral interventions (social support, stress reduction, or positive psychology) and/or drug interventions of stress response (such as beta-blocker therapy) may be a promising strategy for improving HCT outcomes, particularly among socially disadvantaged populations.鈥�
Using RNA sequencing, investigators from the 91大神Cancer Center, Center for International Blood & Marrow Transplant Research (CIBMTR), and MCW鈥檚 Institute for Health and Equity analyzed pre-transplant blood samples from 121 patients across eight transplant centers. In parallel, they examined patient-reported outcome (PRO) data from socio-demographic surveys鈥攁 Short Form Health Survey that measures physical and mental health, and a Functional Assessment of Cancer Therapy-Bone Marrow Transplant that measures physical, social, emotional, and functional well-being as well as transplant-specific items. Leveraging the CIBMTR outcomes database, which contains data from more than 675,000 patients, investigators compared the cohort鈥檚 PRO data to the general US population. 鈥淐IBMTR has biological specimens and PRO data linked, at the patient level, to well-curated clinical outcomes data, making it an ideal resource to test these complex hypotheses,鈥� said Bronwen Shaw, MD, PhD, professor of medicine and CIBMTR Chief Scientific Director.
Further research is needed to understand the biological mechanisms underlying cancer outcome disparities associated with adverse social determinants of health (SDOH) in the transplantation and cellular therapy setting. 鈥淭his includes investigating the impact of donor SDOH on recipient outcomes, whether these relationships persist in the pediatric HCT setting, expansion into chimeric antigen receptor (CAR) T-cell therapy recipients, and the effect of candidate interventions on clinical outcomes,鈥� said Dr. Knight. 鈥淲e also aim to better understand resilience factors as we identify both vulnerability and protective factors.鈥�
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