The 51st Annual Meeting of the European Society for Blood and Marrow Transplantation: Psychiatry and Psychology Group – Poster Session (910–918)
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November 5, 2025
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0 min
Psychological Issues in Hematopoietic Stem Cell Transplantation: End-of-Life Care and Parental Distress
Overview
Two studies presented at the 51st EBMT meeting highlight critical psychological challenges in HSCT patients and their families. One study reveals high medical care aggressiveness at end-of-life in non-remission acute leukemia patients post-HSCT, while another documents severe parental distress during transition to palliative care after unsuccessful pediatric HSCT.
Background
Allogeneic hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for acute leukemias but carries a high risk of treatment failure and mortality. Understanding end-of-life care patterns and psychological distress in patients and families is essential to improve supportive care. Psychological and palliative care integration remains challenging, especially when transitioning from curative to palliative intent after HSCT failure.
Data Highlights
| Parameter | Value |
|---|---|
| Number of patients (non-CR acute leukemia HSCT) | 92 |
| Deaths during follow-up | 78 (84.8%) |
| Median survival (months) | 6.3 |
| 2-year overall survival probability | 29.4% |
| Deaths due to relapse | 59% (46 patients) |
| Deaths in inpatient setting | 86.5% |
| Deaths in ICU | 39.2% |
| Mechanical ventilation at end-of-life | 32% |
| Continuous hospitalization from transplant to death | 28.2% |
| Referral to palliative care team | 21.8% |
| Deaths in palliative care unit | 2.7% (2 patients) |
| Parental distress mean score (Distress Thermometer) | 7.9 (median 8) |
| Parents reporting financial problems | 63% |
| Parents reporting anxiety | 89% |
| Parents refusing opioid pain relief | 37% |
Key Findings
- End-of-life medical care aggressiveness is high in patients undergoing HSCT for non-remission acute leukemia, with frequent ICU deaths and mechanical ventilation use.
- Cause of death (relapse vs. non-relapse) significantly influences aggressiveness indicators; patients dying without relapse experience more aggressive care.
- Pre-transplant clinical factors do not significantly impact end-of-life care aggressiveness.
- Parental distress during transition to palliative care after unsuccessful pediatric HSCT is extremely high, with predominant anxiety, fear, and fatigue.
- Parents often struggle to accept transition to palliative care, frequently demanding continued treatment and second opinions, and may reject pain relief and technical aids.
- Communication barriers exist between parents, children, and medical staff, complicating emotional support and decision-making.
Clinical Implications
These findings underscore the importance of early and ongoing advance care planning and palliative care integration throughout the HSCT trajectory, especially for patients with poor prognosis. Psychosocial support services should be prioritized for families, particularly parents facing the transition to palliative care, to address distress and improve communication. Anticipating end-of-life trajectories without relapse and supporting acceptance of care goals may reduce unnecessary aggressive interventions.
Conclusion
The studies highlight significant psychological and care challenges in HSCT patients and their families, emphasizing the need for enhanced palliative care integration and psychosocial support to improve end-of-life experiences and family coping.
References
- Bauschert et al. 2025 -- Medical Care Aggressiveness at End-of-Life After Allogeneic Transplantation for Non-CR Acute Leukemia
- Rogachev 2025 -- Parental Distress and Challenges in Accepting Transition to Palliative Care After HSCT
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