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Updated: Jun 12, 2026
Competitive Transplants to Evaluate Hematopoietic Stem Cell Fitness
Published on: August 31, 2016
Validation of the human activity profile questionnaire in patients after allogeneic hematopoietic stem cell
Philipp Yorck Herzberg1, Pia Heussner, Friederike H A Mumm
1Department of Medical Psychology and Sociology, University of Leipzig, Leipzig, Germany.
Insights
The Human Activity Profile (HAP) is a valid tool for assessing physical activity in patients after allogeneic stem cell transplant. It effectively detects changes in chronic graft-versus-host disease (cGVHD) activity, showing higher sensitivity than other quality-of-life measures.
Area of Science:
- Hematology
- Transplantation immunology
- Quality of Life Research
Background:
- Chronic graft-versus-host disease (cGVHD) significantly impacts morbidity and mortality after allogeneic hematopoietic stem cell transplantation (alloHSCT).
- Current methods for monitoring cGVHD activity in clinical trials lack validation.
- The Human Activity Profile (HAP) was proposed as a patient self-report measure for functional status and cGVHD improvement but required validation in alloHSCT patients.
Purpose of the Study:
- To validate the Human Activity Profile (HAP) as a measure of physical activity and cGVHD status in patients who have undergone alloHSCT.
- To assess the correlation of HAP scores with cGVHD severity, clinical manifestations, and other quality-of-life instruments.
- To evaluate the sensitivity of the HAP in detecting changes in cGVHD activity.
Main Methods:
- A cohort of 176 patients post-alloHSCT were evaluated using a German translation of the HAP, NIH criteria for cGVHD, Lee cGVHD Symptom-Scale, FACT-BMT, SF36, and other psychosocial measures.
- Patients were assessed at baseline and followed for 12 months with repeated surveys.
- Correlations between HAP scores (Maximum Activity Score - MAS, Adjusted Activity Score - AAS) and cGVHD severity, lung manifestations, and other scales were analyzed.
Main Results:
- HAP scores (MAS and AAS) inversely correlated with cGVHD severity.
- Lung cGVHD manifestations correlated with AAS.
- HAP scores demonstrated significant correlations with physical functioning scales (SF36) and showed higher sensitivity to cGVHD activity changes compared to SF36 and FACT-BMT.
- Steroid myopathy correlated with HAP scores, but not SF36.
Conclusions:
- The HAP is a simple, valid questionnaire for evaluating physical activity in patients post-alloHSCT.
- The HAP can detect changes in cGVHD status independently of other quality-of-life measures.
- The HAP offers superior sensitivity in monitoring cGVHD activity compared to the SF36, making it a valuable tool for clinical trials.
Abstract:
Chronic graft-versus-host disease (cGVHD) associated morbidity and mortality remain major barriers for successful allogeneic hematopoietic stem cell transplantation (alloHSCT). Currently, no reliable measures are established to monitor cGVHD activity changes for use in clinical trials. The Human Activity Profile (HAP) patient self-report was proposed by the National Institutes of Health (NIH) cGVHD consensus project as an independent measure of patients' functional status that could also indirectly reflect improvement of cGVHD, but that has not been validated in an alloHSCT patient population. One hundred seventy-six patients (median age 44 years [range: 18-72 years] after alloHSCT were evaluated with a German translation of the HAP, the NIH criteria-based cGVHD activity assessment, the Lee cGVHD Symptom-Scale, FACT-BMT, SF36, Berlin Social Support Scale, 24-Item Adjective Measure (24-AM), Hospital Anxiety and Depression Scale, and the NCCN-Distress-Thermometer. Enrollment occurred a median of 286 (range: 85-4003) days after alloHSCT. Follow-up surveys were conducted at 1, 2, 3, 5, 8, and 12 months after the baseline survey. Although 117 patient had cGVHD at time of enrollment (mild n = 33, moderate n = 50, or severe n = 34), 59 patients were included into the study in the absence of cGVHD between days 85 and 395 after transplantation. The maximum activity score (MAS) and adjusted activity score (AAS) of the HAP correlated inversely with grading of cGVHD severity (mild, moderate, or severe) (r = -0.25 for MAS and -0.24 for AAS). Lung manifestations of cGVHD correlated with AAS (r = 0.17), but not with MAS. HAP scores correlated with subscales from other instruments measuring physical domains, especially the physical functioning scale of the SF36. Performance was improved by use of an HSCT-modified HAP scoring system that excluded activities prohibited within the first year after alloHSCT. No significant correlation of the HAP was found with personality, age, sex, symptom burden, or social functioning or social well-being. Moreover, the HAP displayed a higher sensitivity to change of cGVHD activity compared to the SF36 and the FACT-BMT. In addition, steroid myopathy correlated with both HAP scores, but not the SF36. The HAP is a simple and valid questionnaire for the evaluation of the physical activity in patients after alloHSCT, with the advantage of detecting changes in cGVHD status independently of other quality-of-life measures and with a superior sensitivity compared to the SF36.
