Exploring the impact of opioid use on outcomes in allogeneic hematopoietic stem cell transplantation

Hematological malignancies and allogeneic hematopoietic cell transplantation (alloHCT) often necessitate the use of opioids due to significant pain. This study aimed to investigate the impact of opioid use on the clinical outcomes of patients undergoing alloHCT.

A retrospective cohort study was conducted by merging data from our local transplant database with anonymized pharmacy records obtained from the Institute for Clinical Evaluative Sciences (ICES). We analyzed 681 patients who underwent alloHCT at Princess Margaret Cancer Centre between January 2010 and December 2019. Patients who initiated opioid use within one-year post-alloHCT and had opioid prescriptions for more than 30 days were categorized as intense opioid users (IOU). Additionally, patients who started opioids before or within one-year post-alloHCT and had opioid prescriptions for less than 30 days but died while on opioids were also classified as IOU. The analytical code used for the analysis is available in the Supporting Information file.

Among the 681 patients, 51 were identified as IOU. The two-year overall survival (OS) was significantly lower in the IOU group, with 29.4% survival compared to 53% in non-IOU (HR 1.77, 95% CI 1.26-2.48, p = 0.0008). Multivariate analysis indicated that IOU status was associated with a 2.32 times higher instantaneous rate of death compared to non-IOU (HR 2.32, 95% CI 1.5-3.5, p = 0.002). The median time for relapse was 147 days in the IOU group (range 52-393) and 209 day for non-IOU (range 96-1793), p = 0.0082. Furthermore, the relapse rate at two years was notably higher in the IOU group (31.4% vs. 16.4%, p = 0.0049). The analysis of factors independently associated with relapse-free survival (LFS) showed that IOU status, age, donor type, and cytogenetic risk were significant predictors. At two years, relapse-free survival was 29.4% in the IOU group compared to 52.5% in the non-IOU group (p < 0.001).

In our study, we found a correlation between intense opioid use in alloHCT patients and worse overall survival, particularly concerning higher relapse rates. These findings highlight the need for further research into pain management strategies to improve outcomes and reduce potential toxicity.