Expectations are associated with psychological and biological outcomes after allogeneic hematopoietic stem cell transplantation in a prospective cohort study

INTRODUCTION: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only curative treatment for many hematologic malignancies, yet patient outcomes vary significantly. Patient expectations influence recovery in other medical contexts, yet their role in allo-HSCT remains unclear. This pilot study examined whether pre-transplant treatment expectations predict psychological and immunological outcomes post-transplant. METHODS: In this prospective, single-center observational cohort study, 42 patients undergoing allo-HSCT were assessed at baseline (T0), discharge (T2), and six months post-transplant (T3). Questionnaires measured illness-related disability (PDI, primary endpoint at T3), treatment expectations (TEX-Q), quality of life (FACT-Leu), depression (PHQ-9), and anxiety (GAD-7). Immunological markers, including inflammatory markers were collected at T0 and T3. Baseline-adjusted regression analyses with full-information maximum likelihood estimation were used. P-values were corrected for multiple comparisons using a false discovery rate approach. RESULTS: Baseline expectations were associated with psychological outcomes at hospital discharge and immunological and inflammatory markers at six-month follow-up: For instance, negative impact expectations were associated with higher disability (β = 0.522, p < 0.001), depression (β = 0.693, p = 0.009), anxiety (β = 0.737, p = 0.003), and lower quality of life (β = -0.576, p < 0.001) at T2. Benefit expectations were associated with higher lymphocyte counts (β = 0.453, p < 0.001) and lower CRP levels at T3 (β = -0.28, p = 0.011). Positive impact expectations were associated with more favorable T-cell subsets. DISCUSSION: Pre-transplant expectations may influence psychological and immune recovery following allo-HSCT. Addressing expectations could enhance outcomes and should be explored in future intervention studies.