Financial Toxicity Post Bone Marrow Transplant Linked to Worse QOL

Financial toxicity generally decreased during the first year after allogeneic bone marrow transplant (BMT), but patients experiencing persistent moderate to high financial hardship reported worsening quality of life (QOL), according to findings from a prospective cohort study.¹

Among 214 adults who underwent allogeneic BMT between 2018 and 2023, the expected probability of experiencing at least mild financial toxicity decreased from 39% at baseline to 26% at 1 year after transplant. However, patients with moderate to high financial toxicity experienced significant deterioration in QOL over the same period, whereas those reporting none to minimal or mild financial toxicity had improvements in QOL.

These findings suggest that although financial hardship may ease for some patients following transplant, persistent financial toxicity can have lasting implications for patient well-being.

Financial Toxicity and Patient Characteristics

The median age of participants was 58 years (IQR, 46-66), 62% were male, and 80% were White. The most common underlying malignancy was leukemia (47%), followed by myelodysplastic syndrome (27%) and lymphoma (9%). At baseline, 56% of patients reported none to minimal financial toxicity, 26% reported mild financial toxicity, and 18% reported moderate to high financial toxicity.

Financial hardship was reflected in cost-cutting behaviors, including reduced spending on food or clothing, use of personal savings, and prescription nonadherence. Patients older than 65 years and those with annual incomes greater than $90,000 had 66% and 67% lower risks of financial toxicity, respectively, compared with their counterparts (relative risk [RR], 0.34; 95% CI, 0.19-0.59; RR, 0.33; 95% CI, 0.20-0.57).

Quality of Life After Transplant

Among 119 patients who were alive and had available data at day 365, QOL improved from baseline among those reporting none to minimal or mild financial toxicity. In contrast, patients with moderate to high financial toxicity experienced significant QOL deterioration over 1 year. Financial toxicity was not significantly associated with posttransplant mortality after adjustment for covariates (HR, 1.10; 95% CI, 0.62-1.96).

Implications for Transplant Care

The findings support longitudinal financial toxicity screening and financial interventions throughout the transplant continuum. Although financial hardship generally decreased during the first year following allogeneic BMT, patients with persistent moderate to high financial toxicity experienced worsening QOL, underscoring the importance of identifying financial challenges that may affect recovery.

Additional evidence supports the relationship between financial well-being and patient outcomes after transplant. In a 2025 study published in Transplantation and Cellular Therapy, Schaefer et al examined 150 adults who underwent allogeneic hematopoietic stem cell transplantation. Lower financial toxicity was associated with improved QOL (β = 0.596; P <.001), as well as lower anxiety, depression, and posttraumatic stress disorder symptoms (all P <.001).² These findings further emphasize the potential value of addressing financial hardship as part of supportive care.

Together, the studies highlight financial toxicity as an important consideration in transplant survivorship and support continued assessment of patients' financial needs alongside clinical and QOL outcomes.

REFERENCES

1. Hussaini SMQ, Maheshwari S, Deng L, et al. Financial Toxicity and Quality of Life After Bone Marrow Transplant: A Longitudinal, Prospective Study. JCO Oncol Prac. Published online September 23, 2026. doi:10.1200/op-26-00421

2. Schaefer DA, Longley RM, Wolfe ED, et al. Financial Toxicity, Psychological Well-Being, and Quality of Life in Hematopoietic Stem Cell Transplantation. Transplant Cell Ther. 2025;31(11):936.e1-936.e10. doi:10.1016/j.jtct.2025.08.012