Developing the Biobehavioral Foundation for Self-Management of Psychoneurological Symptoms in Hematopoietic Cell Transplant (HCT) Survivors

为造血细胞移植（HCT）幸存者的心理神经症状的自我管理建立生物行为基础

• 批准号: 9668844
• 负责人: Debra L. Kelly
• 金额: $ 19.06万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-27 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9668844
• 关键词: 18 year old; Address; Admission activity; Adult; Affect; Age; American Society of Clinical Oncology; Anxiety; Aplastic Anemia; Behavioral; Biological; Biological Factors; Bone Marrow Transplantation; Breast; C-reactive protein; Cancer Survivor; Carbohydrates; Caregivers; Cell Transplants; Cells; Characteristics; Chronic Disease; Clinical; Complex; Consumption; Continuance of life; Data; Data Collection; Development; Diet; Diet and Nutrition; Dietary Intervention; Distress; Donor person; Dysmyelopoietic Syndromes; Emotional; Ethnic Origin; Face; Fatigue; Fatty acid glycerol esters; Feasibility Studies; Florida; Foundations; Frequencies; Functional disorder; Future; Goals; Habits; Health; Hematological Disease; Hematopoietic; Hospitals; Individual; Inflammation; Inflammatory; Inflammatory Response; Intervention; Knowledge; Label; Late Effects; Lead; Life; Life Style; Literature; Long-Term Survivors; Lung; Macronutrients Nutrition; Malignant Neoplasms; Measures; Mental Depression; Mental Health; Methodology; Modeling; Mucous Membrane; Neurocognitive; Pain; Participant; Pathway interactions; Patients; Population; Procedures; Production; Prostate; Proteins; Psyche structure; Quality of life; Race; Regimen; Reporting; Research; Sampling; Self Management; Severities; Sickle Cell Anemia; Study models; Survival Rate; Survivors; Symptoms; Technology; Testing; Time; Transplant Recipients; Transplantation; Treatment Protocols; Treatment outcome; United States; United States National Institutes of Health; Universities; anxiety symptoms; behavioral response; biobehavior; cancer diagnosis; cohort; conditioning; cytokine; depressive symptoms; design; gut microbiota; health related quality of life; hematopoietic cell transplantation; improved; innovation; leukemia/lymphoma; microbiota-gut-brain axis; patient population; persistent symptom; personalized strategies; physical conditioning; prospective; recruit; retention rate; sex; symptom management; symptom science; targeted treatment; transplant centers

Project Summary/Abstract Our long-term goal is to elucidate biobehavioral mechanisms contributing to distressing symptoms in hematopoietic cell transplantation (HCT) survivors for the development and implementation of targeted therapies to improve quality of life (QOL) in this patient population. Due to treatment advances, HCT is becoming an increasingly viable option for individuals with life-threatening hematologic disorders and the number of survivors is increasing. Thus, survivorship issues such as distressing symptoms of neurocognitive dysfunction, fatigue, anxiety and depressive symptoms, and pain collectively labeled as “psychoneurologic” (PN) symptoms are a major issue. To date, little is known about the suspected shared biological underpinnings influencing PN symptoms. Inflammation is a generally accepted mechanism of PN symptoms in multiple chronic illnesses, including cancer. Emerging evidence of gut microbiota, via the microbiota-gut-brain-axis, as a potential pathway for the initiation of an inflammatory response may lead to innovative strategies, including diet and nutrition strategies to reduce inflammation. Understanding the interplay among diet and the gut microbiota with inflammation and PN symptoms may provide information leading to targeted self-management strategies to mitigate PN symptoms in individuals following HCT. The specific aims of this study are to: 1) Evaluate study feasibility of data collection, acceptability of study procedures including recruitment and retention, and missingness of data, 2) Characterize the strength of the associations (effect sizes) at baseline (14-7 days prior to hospital admission for HCT conditioning) among patient factors, PN symptoms, inflammation, GM and diet and 3) Estimate associations (effect sizes) and models for change over time (14-7 days prior to hospital admission for HCT conditioning, 30 and 100 days after HCT) for: a) Patient factors and PN symptoms with Inflammation b) Patient factors, PN symptoms and Inflammation with GM c) Patient factors, PN symptoms, Inflammation and GM with Diet d) Patient factors, Diet, GM and Inflammation with PN symptoms. To achieve these aims, we will longitudinally examine 50 adult (> 18 years of age) HCT recipients recruited from the University of Florida Bone Marrow Transplant Center. We will characterize patient factors (age, sex, race, ethnicity, BMI, lifestyle habits, and clinical factors [cancer diagnosis, conditioning regimen, type of transplant]); systemic inflammation (cytokines and C-reactive protein); gut microbiota (richness and diversity); diet (consumption of macronutrients); and PN symptoms (neurocognitive dysfunction, fatigue, anxiety, depression, and pain) at baseline (two weeks or less prior to HCT), 30 and 100 days following HCT. State-of-the-art technology will be used to analyze the biological samples and innovative Bayesian statistical methodologies will be used to test the models of the study variables. This knowledge is critical to provide a foundation for developing a targeted diet self-management intervention to address this major survivorship issue and improve QOL for HCT recipients.

项目概要/摘要 我们的长期目标是阐明导致痛苦症状的生物行为机制 造血细胞移植（HCT）幸存者开发和实施靶向治疗 由于治疗的进步，HCT 正在成为一种改善该患者群体的生活质量 (QOL) 的方法。 对于患有危及生命的血液疾病的个体和幸存者数量来说，越来越可行的选择 因此，诸如神经认知功能障碍、疲劳等令人痛苦的症状的生存问题正在增加。 焦虑和抑郁症状以及统称为“精神神经”（PN）症状的疼痛是一种 迄今为止，人们对影响 PN 的疑似共同生物学基础知之甚少。 炎症是多种慢性疾病中 PN 症状的普遍接受的机制。 包括肠道微生物群通过微生物群-肠-脑轴作为潜在途径的新证据。 炎症反应的启动可能会导致创新策略，包括饮食和营养 了解饮食和肠道微生物群之间的相互作用。 炎症和 PN 症状可能提供信息，从而制定有针对性的自我管理策略 减轻 HCT 后个体的 PN 症状 本研究的具体目的是： 1) 评估研究。 数据收集的可行性、研究程序（包括招募和保留）的可接受性，以及 数据缺失，2) 描述基线时（14-7 天前）关联的强度（效应大小） 入院进行 HCT 调理）患者因素、PN 症状、炎症、GM 和饮食 3) 估计随时间变化的关联（效应大小）和模型（入院前 14-7 天） 入院进行 HCT 调理（HCT 后 30 和 100 天），用于： a) 患者因素和 PN 症状 炎症 b) 患者因素、PN 症状和 GM 炎症 c) 患者因素、PN 症状、 炎症和 GM 与饮食 d) 患者因素、饮食、GM 和炎症与 PN 症状。 为了实现这些目标，我们将纵向研究从以下机构招募的 50 名成人（> 18 岁）HCT 接受者： 佛罗里达大学骨髓移植中心我们将描述患者因素（年龄、性别、种族、 种族、BMI、生活习惯和临床因素[癌症诊断、调理方案、移植类型]）； 全身炎症（细胞因子和 C 反应蛋白）；肠道微生物群（丰富性和多样性）； （大量营养素的消耗）；和 PN 症状（神经认知功能障碍、疲劳、焦虑、抑郁、 和疼痛）在基线（HCT 前两周或更短时间）、HCT 后 30 和 100 天。 技术将用于分析生物样本，创新的贝叶斯统计方法将 用于测试研究变量的模型对于为开发提供基础至关重要。 有针对性的饮食自我管理干预措施，以解决这一主要的生存问题并改善 HCT 的生活质量 收件人。