The research, led by Gabriela Lampart of the Doctoral School of Medical and Health Sciences at Jagiellonian University Medical College in Krakow, followed adult transplant recipients at a single center, the Department of Hematology at University Hospital in Krakow. Patients completed validated questionnaires at three carefully chosen timepoints: within twenty-four hours after the infusion of donor stem cells, at one month, and at six months. Fatigue was measured with two complementary instruments, the Functional Assessment of Chronic Illness Therapy-Fatigue scale, known as FACIT-F, and the Brief Fatigue Inventory, or BFI. Quality of life was captured with the Functional Assessment of Cancer Therapy-Bone Marrow Transplant questionnaire, FACT-BMT, which spans physical, social and family, emotional, and functional well-being alongside transplant-specific concerns.

Of forty-one patients enrolled in the parent longitudinal project, twenty-eight completed all three early assessments and formed the primary complete-case cohort. The remaining thirteen were excluded from the primary analysis because of death before the six-month follow-up or loss to follow-up, including changes of treatment center. The cohort was predominantly female, with seventeen women and eleven men, and was split roughly evenly between younger and older patients relative to the sample mean age of forty-eight years. Importantly, no statistically significant baseline differences were detected between patients who later developed graft-versus-host disease and those who did not, although the authors caution that such comparisons in a small sample are descriptive rather than definitive.

Graft-versus-host disease, or GVHD, arises when donor immune cells recognize the recipient’s tissues as foreign and mount an attack. It is one of the most frequent and clinically consequential complications of allo-HSCT. In this study, exactly half of the cohort, fourteen patients, developed GVHD during early follow-up. Six had acute disease and eight had chronic disease. The skin was the most commonly affected organ, involved in eight patients, followed by the gastrointestinal tract in four and the liver in two. Treatment responses were documented with the help of the eGVHD application developed at UZ Leuven in Belgium, and patients were classified as responders if they achieved a complete or partial response, and non-responders otherwise. Eight patients responded to therapy while six did not.

The statistical architecture of the study rested on linear mixed-effects models, a technique well suited to repeated measurements within the same individuals because it accounts for the fact that observations from one patient are correlated over time. The results were strikingly consistent. Quality of life improved significantly over the six months, and fatigue declined in parallel, with all time effects reaching statistical significance at p less than 0.001. But overlaying this general recovery was a persistent divide: patients who developed GVHD reported consistently worse outcomes at every timepoint. The GVHD effect was highly significant for FACT-BMT, BFI, and FACIT-F alike, and, notably, the time-by-GVHD interactions were not significant, indicating that the two groups recovered along broadly parallel trajectories rather than diverging over time.

The magnitude of the differences is clinically meaningful. At the first assessment, patients without GVHD reported a mean FACT-BMT score of 96.4, rising to 123.6 by six months. GVHD responders started far lower at 72.4 and reached only 92.4, while non-responders began at 49.2 and climbed to just 74.3. Fatigue told the mirror-image story. On the BFI, where higher scores indicate greater fatigue and interference with daily life, non-responders scored 8.5 at the outset and still 7.0 at six months, compared with 6.1 falling to 4.7 among patients free of GVHD. On the FACIT-F, where higher scores mean less fatigue, non-responders languished at 9.7 initially and 16.3 at six months, against 23.3 and 30.4 in the no-GVHD group.

Perhaps the most powerful finding concerns the relationship between fatigue and quality of life itself. Across all eighty-four pooled observations, FACT-BMT scores correlated negatively with BFI at r equal to minus 0.813 and positively with FACIT-F at r equal to 0.857, both highly significant. The two fatigue instruments were almost perfectly inversely correlated, at r equal to minus 0.957, confirming they capture the same underlying construct from opposite directions. Crucially, fatigue remained an independent correlate of quality of life in multivariable models that adjusted for time, GVHD status, sex, and age group. In the model using BFI, each unit increase in fatigue was associated with a drop of roughly eight points in FACT-BMT, while GVHD itself carried an independent penalty of nearly twenty-four points.

Within the GVHD subgroup, an exploratory analysis revealed that response to treatment further stratified outcomes. Responders enjoyed significantly better quality of life and lower fatigue than non-responders, with p-values of 0.016 for FACT-BMT, below 0.001 for BFI, and 0.017 for FACIT-F. Again, the absence of significant time-by-response interactions suggested that these differences were sustained rather than widening or narrowing. The authors are careful to frame this comparison as hypothesis-generating, since treatment response was defined during follow-up and the subgroup was small. Subscale analyses added nuance: physical and functional well-being showed the largest deficits associated with GVHD, emotional well-being was also significantly affected, while social and family well-being appeared relatively preserved, perhaps reflecting the buffering role of social support during severe illness.

The study’s limitations deserve honest attention. The single-center design and small sample constrain generalizability, and the complete-case approach may have introduced selection bias, because patients who died, relapsed, or deteriorated clinically were less likely to complete all assessments. Missing data in this setting may be informative rather than random, meaning the observed recovery could be overestimated relative to an unselected transplant population. Sensitivity analyses including all available early assessments showed consistent directions of association, which strengthens confidence, but the authors also note that there was no true pre-transplant baseline, since the first measurement came after conditioning therapy, when symptom burden was already substantial. Because GVHD status was defined cumulatively during follow-up, early group differences may partly reflect pre-existing vulnerability rather than the direct effects of the disease itself.

Even with these caveats, the clinical implications are clear and actionable. The authors argue that fatigue should be treated not as an inevitable side effect to be endured, but as a potentially modifiable target for supportive care. Candidate interventions include individualized exercise-based rehabilitation, physiotherapy, gradual physical activity programs, psychosocial support, fatigue education, sleep optimization, nutritional support, and systematic management of contributing conditions such as pain, anemia, infections, endocrine dysfunction, depression, and anxiety. In patients with GVHD, fatigue management must be woven into GVHD treatment itself, adapted to immunosuppressive regimens, infection risk, and functional limitations. Structured patient-reported outcome monitoring, reviewed systematically by the care team and linked to timely interventions, could transform how the most vulnerable months after transplantation are managed. As the parent project extends follow-up to twenty-four months, larger multicenter studies will be needed to confirm whether early fatigue trajectories can serve as warning signs of poor GVHD control, and whether fatigue-directed interventions can genuinely bend the quality-of-life curve for transplant survivors.

Subject of Research: Fatigue and quality of life dynamics during the first six months after allogeneic hematopoietic stem cell transplantation and the impact of graft-versus-host disease

Article Title: Fatigue and quality of life in the early phase after allogeneic hematopoietic stem cell transplantation: dynamics and the impact of graft-versus-host disease

Article References: Lampart, G., Kubarek, M., Gniadek, A., & Piątkowska-Jakubas, B. (2026). Fatigue and quality of life in the early phase after allogeneic hematopoietic stem cell transplantation: dynamics and the impact of graft-versus-host disease. Supportive Care in Cancer, 34(11), Article 1081. https://doi.org/10.1007/s00520-026-11220-w

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11220-w

Keywords: allogeneic hematopoietic stem cell transplantation, graft-versus-host disease, fatigue, quality of life, patient-reported outcomes, FACT-BMT, FACIT-F, Brief Fatigue Inventory, supportive care, hematological malignancies, longitudinal study, bone marrow transplantation