Return to Work After Hematopoietic Stem Cell Transplantation: A Longitudinal Analysis of Fatigue and Organ-Specific Chronic Graft-versus-Host Disease.

BACKGROUND: Return to work (RTW) indicates long-term functional recovery following hematopoietic stem cell transplantation (HSCT), yet the impact of organ-specific chronic graft-versus-host disease (cGvHD) remains understudied. OBJECTIVE: To determine the probability and timing of RTW and identify its predictors, specifically fatigue and organ-specific cGvHD, using longitudinal nursing data. METHODS: This retrospective cohort study analyzed 2,334 longitudinal nursing assessment records from 80 HSCT recipients (2016-2021). The probability of RTW over time was estimated using the Kaplan-Meier method. Time-dependent Cox regression models were used to identify predictors while adjusting for age, sex, and clinical confounders. RESULTS: The median follow-up was 507 days (interquartile range [IQR] 224-797). The median time to RTW was 312.5 days (IQR 144.0-567.2). The Kaplan-Meier-estimated probability of RTW was 17.8%, 34.1%, and 53.3% at 6, 12, and 24 months, respectively. Multivariable analysis revealed that allogeneic HSCT (hazard ratio [HR]=0.17, p < 0.001) and high fatigue (≥ 4) (HR=0.67, p=0.029) were significant predictors of delayed RTW. Among allogeneic recipients, joint/fascia involvement (HR=0.39, p=0.003) was associated with reduced RTW likelihood. CONCLUSIONS: RTW after HSCT is a delayed and symptom-driven recovery process. Fatigue was a universal barrier across transplant types, while allogeneic recipients faced additional obstacles from organ-specific cGvHD. Systematic assessment and targeted rehabilitation for fatigue and musculoskeletal manifestations are essential to support vocational reintegration. Although pulmonary involvement did not reach statistical significance, it showed a trend toward delayed RTW and warrants further investigation.