In patients undergoing stem cell transplantation (SCT), nonadherence has potential for significant medical impact and potentially life-threatening complications. No study thus far has demonstrated an effective way to predict adherence in SCT recipients. A structured rating scale, the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), has been shown to predict psychosocial outcomes and medical morbidity in solid organ transplant recipients. We assessed the SIPAT in SCT recipients. We hypothesized that the SIPAT rating would be associated with nonadherence to the post-SCT regimen. We retrospectively studied SCT recipients who had psychiatric evaluations with the SIPAT before SCT. The primary outcome was nonadherence, defined a priori as at least 1 life-threatening nonadherence event in the first 6 months post-transplant. Association of the SIPAT with outcomes was evaluated by logistic regression, and an optimal cutoff score was determined using a receiver operating characteristic curve. Of 85 patients (mean age 47 years; range, 18 to 74 years), 56 (66%) were male, and 43 (50.5%) received autologous SCT. Eighteen (21%) patients were nonadherent. The SIPAT rating, treated as a continuous variable and controlling for autologous versus allogeneic SCT, was significantly associated with nonadherence (per 1 point; odds ratio [OR], 1.162; P< .0001). Allogeneic SCT also conferred a significantly increased risk of nonadherence (OR, 14.184; P= .005). Multivariate analysis stratifying for allogeneic versus autologous transplantation and controlling for age, sex, and disease confirmed an independent association between the SIPAT score and nonadherence. A cutoff score of 18 provided optimal specificity (89.6%) and sensitivity (55.6%) for nonadherence. Nonadherence rates were 58.8% and 11.8% for subjects with SIPAT ratings of 18 and above or 17 and below, respectively (relative risk = 4.98, P < .0001). Psychosocial risk as quantified by the SIPAT correlated with SCT recipients' adherence to the post-transplant regimen, suggesting that this instrument can contribute to medical risk stratification models. Further study should evaluate long-term mortality data and the effects of intervention on psychosocial risks.

中文翻译：

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造血干细胞移植之前的标准化半结构化社会心理评估可预测患者对移植后方案的依从性。

在进行干细胞移植（SCT）的患者中，不坚持治疗可能会产生重大的医学影响，并可能危及生命。迄今为止，尚无研究表明预测SCT接受者依从性的有效方法。已经显示出结构化的评分量表，即斯坦福大学移植的社会心理综合评估（SIPAT），可以预测实体器官移植接受者的社会心理结局和医疗发病率。我们评估了SCT接受者中的SIPAT。我们假设SIPAT评分与SCT后治疗方案的不遵守有关。我们回顾性研究了SCT前接受SIPAT精神评估的SCT接受者。主要结局为不依从，定义为先验为移植后前6个月至少有1次威胁生命的不依从事件。通过logistic回归评估SIPAT与结果的关联，并使用接收器工作特征曲线确定最佳临界值。85例患者（平均年龄47岁；范围18至74岁）中，男性56例（66％），而自体SCT的43例（50.5％）。18位（21％）患者未坚持治疗。SIPAT评分被视为连续变量并控制自体与异体SCT，与不依从性显着相关（每1分；优势比[OR]为1.162； P <.0001）。同种异体SCT还导致明显的不依从风险（OR，14.184； P = .005）。对同种异体移植与自体移植进行分层并控制年龄，性别和疾病的多变量分析证实了SIPAT评分与不依从性之间存在独立的关联。截止评分为18，可为非依从性提供最佳特异性（89.6％）和敏感性（55.6％）。SIPAT等级为18以上或17以下的受试者的不依从率分别为58.8％和11.8％（相对风险= 4.98，P <.0001）。由SIPAT量化的社会心理风险与SCT接受者对移植后治疗方案的依从性相关，这表明该工具可有助于医疗风险分层模型。进一步的研究应评估长期死亡率数据以及干预措施对社会心理风险的影响。由SIPAT量化的社会心理风险与SCT接受者对移植后治疗方案的依从性相关，这表明该工具可有助于医疗风险分层模型。进一步的研究应评估长期死亡率数据以及干预措施对社会心理风险的影响。由SIPAT量化的社会心理风险与SCT接受者对移植后治疗方案的依从性相关，这表明该工具可有助于医疗风险分层模型。进一步的研究应评估长期死亡率数据以及干预措施对社会心理风险的影响。