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: 9794767
• 负责人: Debra L. Kelly
• 金额: $ 22.88万
• 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 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9794767
• 关键词: 18 year old; Address; 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; 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; Hematological Disease; Hematopoietic; Hospitalization; 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; Transplantation Conditioning; 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 goals; 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; transplant survivor

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.

项目摘要/摘要 我们的长期目标是阐明有助于令人痛苦符号的生物行为机制 造血细胞移植（HCT）生存，用于开发和实施目标疗法 改善该患者人群的生活质量（QOL）。由于治疗的进展，HCT已成为 对于患有生命的血液学障碍和幸存者人数的人来说，越来越可行的选择 正在增加。这就是面战问题，例如神经认知功能障碍，疲劳的令人痛苦的症状 焦虑和抑郁症状以及疼痛集体标记为“心理功能学”（PN）症状是一种 主要问题。迄今为止，关于可疑共享的生物基础影响PN知之甚少 症状。炎症是多种慢性疾病中PN症状的公认机制， 包括癌症。通过微生物群 - 脑轴作为潜在途径的肠道菌群的新兴证据 对于炎症反应的倡议，可能会导致创新策略，包括饮食和营养 减少炎症的策略。了解饮食与肠道菌群之间的相互作用 炎症和PN符号可能会提供有针对性的自我管理策略的信息 减轻HCT后个体的PN症状。这项研究的具体目的是：1）评估研究 数据收集的可行性，包括招聘和保留在内的研究程序的可接受性以及 数据的缺失，2）表征基线相关的强度（效应大小）（14-7天 在患者因素，PN症状，注射，GM和饮食中，接受HCT调节的住院 3）估计关联（效应大小）和随时间变化的模型（医院前14-7天） HCT调节的入院，HCT 30和100天）：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， 饮食d）患者因素，饮食，转基因和炎症的炎症和通用汽车带有PN症状。实现 这些目的，我们将纵向研究50名成年人（> 18岁）HCT接受者招募从 佛罗里达大学骨髓移植中心。我们将表征患者因素（年龄，性别，种族， 种族，BMI，生活方式习惯和临床因素[癌症诊断，调节方案，移植类型]）； 全身炎症（细胞因子和C反应蛋白）；肠道菌群（丰富性和多样性）；饮食 （大量营养素的消费）；和PN符号（神经认知功能障碍，疲劳，焦虑，抑郁， HCT之后的30天和100天，基线（在HCT之前两周或更短的时间）时进行疼痛）。最先进的 技术将用于分析生物样品，创新的贝叶斯统计方法将 用于测试研究变量的模型。这些知识对于为发展提供基础至关重要 有针对性的饮食自我管理干预措施解决这一重大生存问题并改善HCT的质量 收件人。