Psychosocial Assessment of Candidates for Transplant (PACT) as a tool for psychological and social evaluation of allogeneic hematopoietic cell transplantation recipients

PsychosocialAssessment of Candidates for Transplant ( PACT) is a tool originally developed to address psychosocialrisks in solid organ transplant recipients and has the potential for application to hematopoietic cell transplantation (HCT) recipients. In a retrospective cohort study, we reviewed 404 adult allogeneic HCT cases from 2003 to 2014 to identify predictors of adverse psychosocialstatus as determined by PACT. Final PACTrating was poor/borderline ( score0–1) in 5%, acceptable ( score2) in 22%, good ( score3) in 44%, and excellent ( score4) in 29% recipients. In multivariable regression, higher PACT scorewas associated with White race (odds ratio [OR] 2.95, P < 0.001), having a related donor (OR 1.61, P = 0.015), and a higher quality of life score(OR 1.22/ 10-point increase in FACT-BMT total score, P < 0.001). PACT scorecorrelated with all quality of life subscales. The final PACT scorewas associated with non-relapse mortality (HR 0.82/ 1-point increase, p = 0.03) in multivariable analysis that considered patient and disease factors, but not in models that also included transplant-related factors and performance status. PACT scorewas not associated with overall survival. PACTcan be considered as part of a comprehensive psychosocialassessment for identifying patients who may require additional resources around allogeneic HCT.