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The haematopoietic stem cell transplant survivors’ sense of coherence about their experiences: a qualitative study

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To explore the experiences of haematopoietic stem cell transplant survivors attending the long-term follow-up unit.


A descriptive qualitative study of eight post-haematopoietic stem cell transplant survivors which were interviewed guided by the sense of coherence framework. Thematic analysis was used to extract meaningful explication of the survivors’ experiences.


The post-haematopoietic stem cell transplant survivors interviewed were five females and three males with age ranging from 27 to 67 years and had the stem cell transplant between 4 and 20 years. Three main themes emerged from the data including (1) comprehending the experience, (2) acknowledging the meaningfulness of the experience and (3) managing threats to a new life after the transplant. The experiences of post-haematopoietic stem cell transplant survivors were initially difficult but they were able to make re-adjustments to their new life by reconciling with their new identity, refocusing on meaningful activities, strengthening their resilience and navigating the healthcare system.


In spite of the difficulties faced by the survivors, they were able to face the challenges and made adjustment in a positive light by focusing on the valuable aspects of their experiences. Health care practitioners need to continually support them throughout their survivorship journey no matter how long it takes. Any long-term follow-up unit is a step in the right direction to meet the complex needs of the survivors by integrating and adapting clinical guidelines into routine oncologic and transplant care so that survivors are not lost in transition following treatment.

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  1. Hatzimichael E, Tuthill M (2010) Hematopoietic stem cell transplantation. Stem Cells Cloning 3:105–117.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Champlin R (2003) Holland-Frei cancer medicine, 6th edition. In: Selection of autologous or allogeneic transplantation. BC Decker, Hamilton, ON

    Google Scholar 

  3. World Health Organisation (WHO). (2018) Haematopoietic stem cell transplantation HSCtx. Retrieved November 19, 2018, from

  4. Gratwohl A, Pasquini MC, Aljurf M, Atsuta Y, Baldomero H, Foeken L et al (2015) One million haemopoietic stem-cell transplants: a retrospective observational study. Lancet Haematol 2(3):e91–e100.

    Article  PubMed  Google Scholar 

  5. Majhail NS, Farnia SH, Carpenter PA, Champlin RE, Crawford S, Marks DI et al (2015) Indications for autologous and allogeneic hematopoietic cell transplantation: guidelines from the American Society for Blood and Marrow Transplantation. Biol

  6. Blood marrow transplant, 21(11), 1863–1869.

  7. Sureda A, Bader P, Cesaro S, Dreger P, Duarte RF, Dufour C, Falkenburg JH, Farge-Bancel D, Gennery A, Kröger N, Lanza F, Marsh JC, Nagler A, Peters C, Velardi A, Mohty M, Madrigal A (2015) Indications for allo- and auto-SCT for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2015. Bone Marrow Transplant 50(8):1037–1056.

    Article  CAS  PubMed  Google Scholar 

  8. Okamoto S (2017) Current indication for hematopoietic cell transplantation in adults. Hematol Oncol Stem Cell Ther 10(4):178–183.

    Article  PubMed  Google Scholar 

  9. Norkin M, Wingard JR (2017) Recent advances in hematopoietic stem cell transplantation. F1000Res 6:870.

  10. Lee SJ, Klein J, Haagenson M, Baxter-Lowe LA, Confer DL, Eapen M, Fernandez-Vina M, Flomenberg N, Horowitz M, Hurley CK, Noreen H, Oudshoorn M, Petersdorf E, Setterholm M, Spellman S, Weisdorf D, Williams TM, Anasetti C (2007) High-resolution donor-recipient HLA matching contributes to the success of unrelated donor marrow transplantation. Blood. 110(13):4576–4583.

    Article  CAS  PubMed  Google Scholar 

  11. Reisner Y, Aversa F, Martelli MF (2015) Haploidentical hematopoietic stem cell transplantation: state of art. Bone Marrow Transplant 50(Suppl 2):S1–S5.

    Article  PubMed  Google Scholar 

  12. Hwang WYK, Poon Z, Bari S (2014) Improving the efficacy and availability of stem sell transplant therapies for hematopoietic stem cell transplantation. J Stem Cell Res Ther 4(6).

  13. Phipps C, Ho AY, Linn YC, Gopalakrishnan S, Ang AL, Lee JJ, Hwang WY (2016) Thirty years of bone marrow transplantation in the Singapore General Hospital. Ann Acad Med Singap 45(7):315–317

    PubMed  Google Scholar 

  14. Hwang J (2017) [Powerpoint] CT- the Singapore experience Retrieved March 8, 2019 from

  15. Hashmi SK, Bredeson C, Duarte RF, Farnia S, Ferrey S, Fitzhugh C, Flowers MED, Gajewski J, Gastineau D, Greenwald M, Jagasia M, Martin P, Rizzo JD, Schmit-Pokorny K, Majhail NS (2017) National Institutes of Health blood and marrow transplant late effects initiative: the Healthcare Delivery Working Group report. Biol Blood Marrow Transplant 23(5):717–725.

    Article  PubMed  Google Scholar 

  16. Henig I, Zuckerman T (2014) Hematopoietic stem cell transplantation—50 years of evolution and future perspectives. Rambam Maimonides Med. J 5(4)

  17. Majhail NS (2017) Long-term complications after hematopoietic cell transplantation. Hematol Oncol Stem Cell Ther 10(4):220–227

    PubMed  PubMed Central  Google Scholar 

  18. Bevans M, El-Jawahri A, Tierney DK, Wiener L, Wood WA, Hoodin F et al (2017) National Institutes of Health hematopoietic cell transplantation late effects initiative: the Patient-Centered Outcomes Working Group report. Biol Blood Marrow Transplant 23(4):538–551

    PubMed  Google Scholar 

  19. Bhatia S, Francisco L, Carter A, Sun CL, Baker KS, Gurney JG et al (2007) Late mortality after allogeneic hematopoietic cell transplantation and functional status of long-term survivors: report from the Bone Marrow Transplant Survivor Study. Blood 110(10):3784–3792.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Clavert, A., Peric, Z., Brissot, E., Malard, F., Guillaume, T., Delaunay, J., . . .Chevallier, P. (2017). Late complications and quality of life after reduced-intensity conditioning allogeneic stem cell transplantation. Biol Blood and Marrow Transplantation, 23(1), 140–146. doi:

  21. Berbis J, Michel G, Chastagner P, Sirvent N, Demeocq F, Plantaz D et al (2013) A French cohort of childhood leukemia survivors: impact of hematopoietic stem cell transplantation on health status and quality of life. Biol Blood and Marrow Transplantation 19(7):1065–1072

    Google Scholar 

  22. Khera N, Chang Y-h, Hashmi S, Slack J, Beebe T, Roy V et al (2014) Financial burden in recipients of allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 20(9):1375–1381

    PubMed  Google Scholar 

  23. Armenian SH, Sun CL, Teh JB, Arora M, Baker KS, Francisco L, Forman SJ, Bhatia S (2010) Ethnic differences in chronic health conditions after hematopoietic cell transplantation: a report from the Bone Marrow Transplant Survivor Study. Cancer 116(17):4152–4159

    PubMed  PubMed Central  Google Scholar 

  24. Stepanikova I, Powroznik K, Cook KS, Tierney DK, Laport GG (2016) Exploring long-term cancer survivors’ experiences in the career and financial domains: interviews with hematopoietic stem cell transplantation recipients. J Psychosol Oncol 34(1–2):2–27

    Google Scholar 

  25. Andrykowski MA, Bishop MM, Hahn EA, Cella DF, Beaumont JL, Brady MJ et al (2005) Long-term health-related quality of life, growth, and spiritual well-being after hematopoietic stem-cell transplantation. J Clin Oncol 23(3):599–608.

    Article  PubMed  Google Scholar 

  26. Rusiewicz A, DuHamel KN, Burkhalter J, Ostroff J, Winkel G, Scigliano E, Redd W (2008) Psychological distress in long-term survivors of hematopoietic stem cell transplantation. Psycho-Oncol 17(4):329–337.

    Article  Google Scholar 

  27. Esser P, Kuba K, Scherwath A, Schirmer L, Schulz-Kindermann F, Dinkel A, Balck F, Koch U, Kröger N, Götze H, Mehnert A (2017) Posttraumatic stress disorder symptomatology in the course of allogeneic HSCT: a prospective study. J Can Survivorship 11(2):203–210.

    Article  Google Scholar 

  28. Rosenberg AR, Syrjala KL, Martin PJ, Flowers ME, Carpenter PA, Salit RB, Baker KS, Lee SJ (2015) Resilience, health, and quality of life among long-term survivors of hematopoietic cell transplantation. Cancer 121(23):4250–4257

    PubMed  PubMed Central  Google Scholar 

  29. Beeken RJ, Eiser C, Dalley C (2011) Health-related quality of life in haematopoietic stem cell transplant survivors: a qualitative study on the role of psychosocial variables and response shifts. Qual Life Res 20(2):153–160

    PubMed  Google Scholar 

  30. Alaloul F, Brockopp DY, Andrykowski MA, Hall LA, Al Nusairat TS (2015) Quality of life in Arab Muslim cancer survivors following hematopoietic stem cell transplantation: comparison with matched healthy group. Support Care Cancer 23(7):2157–2164

    PubMed  Google Scholar 

  31. Bieri S, Roosnek E, Helg C, Verholen F, Robert D, Chapuis B, Passweg J, Miralbell R, Chalandon Y (2008) Quality of life and social integration after allogeneic hematopoietic SCT. Bone Marrow Transplant 42(12):819–827

    CAS  PubMed  Google Scholar 

  32. Higginson IJ, Carr AJ (2001) Using quality of life measures in the clinical setting. Bmj 322(7297):1297–1300

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Forman SJ, Nakamura R (2015) Hematopoietic cell transplantation. Retrieved February 3, 2019 from

  34. Battiwalla M, Tichelli A, Majhail NS (2017) Reprint of: long-term survivorship after hematopoietic cell transplantation: roadmap for research and care. Biol Blood Marrow Transplant 23(3s):S1–s9.

    Article  PubMed  Google Scholar 

  35. Hammarberg K, Kirkman M, De Lacey S (2016) Qualitative research methods: when to use them and how to judge them. Hum Reprod 31(3):498–501

    CAS  PubMed  Google Scholar 

  36. Kerr C, Nixon A, Wild D (2010) Assessing and demonstrating data saturation in qualitative inquiry supporting patient-reported outcomes research. Expert Rev Pharmacoecon Outcomes Res 10(3):269–281

    PubMed  Google Scholar 

  37. Antonovsky H, Sagy S (1986) The development of a sense of coherence and its impact on responses to stress situations. J Soc Psychol 126(2):213–225

    CAS  PubMed  Google Scholar 

  38. Eriksson M (2017) The sense of coherence in the salutogenic model of health. In: The handbook of salutogenesis. Springer. International Publishing, Cham (CH), pp 91–96

    Google Scholar 

  39. Lindblad C, Langius-EklÖff A, Petersson L-M, Sackey H, Bottai M, Sandelin K (2018) Sense of coherence is a predictor of survival: a retrospective study in women treated for breast cancer. Psycho-Oncol. 27:1615–1621.

    Article  Google Scholar 

  40. Malterud K, Siersma VD, Guassora AD (2016) Sample size in qualitative interview studies: guided by information power. Qual Health Res 26(13):1753–1760

    PubMed  Google Scholar 

  41. Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101.

    Article  Google Scholar 

  42. Thomas E, Magilvy JK (2011) Qualitative rigor or research validity in qualitative research. J Spec Pediatr Nurs 16(2):151–155

    PubMed  Google Scholar 

  43. Little M, Paul K, Jordens CF, Sayers EJ (2002) Survivorship and discourses of identity. Psycho-Oncol 11(2):170–178.

    Article  Google Scholar 

  44. Greenblatt A, Lee E (2018) Cancer survivorship and identity: what about the role of oncology social workers? Soc Work Health Care 57(10):811–833

    PubMed  Google Scholar 

  45. Brice, L., Gilroy, N., Dyer, G., Kabir, M., Greenwood, M., Larsen, S., . . .Kerridge, I. (2017). Haematopoietic stem cell transplantation survivorship and quality of life: is it a small world after all? Support. Care Cancer, 25(2), 421–427. doi:

  46. Hara R, Blum D (2009) Social well-being and cancer survivorship. Oncology 23(2):40–50

    PubMed  Google Scholar 

  47. Mak AKY, Ho SS, Kim HJ (2014) Factors related to employers’ intent to hire, retain and accommodate cancer survivors: the Singapore perspective. J Occupational Rehab 24(4):725–731

    Google Scholar 

  48. Sapp AL, Trentham-Dietz A, Newcomb PA, Hampton JM, Moinpour CM, Remington PL (2003) Social networks and quality of life among female long-term colorectal cancer survivors. Cancer 98(8):1749–1758

    PubMed  Google Scholar 

  49. Dyer G, Larsen SR, Gilroy N, Brice L, Greenwood M, Hertzberg M et al (2016) Adherence to cancer screening guidelines in Australian survivors of allogeneic blood and marrow transplantation (BMT). Cancer Med 5(7):1702–1716

    PubMed  PubMed Central  Google Scholar 

  50. Gibson AF, Lee C, Crabb S (2015) ‘Take ownership of your condition’: Australian women’s health and risk talk in relation to their experiences of breast cancer. Health Risk Soc 17(2):132–148

    Google Scholar 

  51. Lustig DC, Rosenthal DA, Strauser DR, Haynes K (2000) The relationship between sense of coherence and adjustment in persons with disabilities. Rehabil Couns Bull 43(3):134–141

    Google Scholar 

  52. Loh KWJ, Ng T, Choo SP, Saw HM, Mahendran R, Tan C et al (2018) Cancer supportive and survivorship care in Singapore: current challenges and future outlook. J Global Oncol 4(1):1–8

    Google Scholar 

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Correspondence to Violeta Lopez.

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Ethical approval involving humans

All procedures conformed with the ethical approval by the institution ethics committee and with the Helsinki declaration. Patients were informed of their rights to withdraw from the study without this affecting their attendance at the HSCT long-term follow-up unit.

Patient consent statement

Signed consent was obtained from all participants in this study. All data collected were de-identified to protect their privacy and maintain confidentiality.

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The authors declare that they have no conflict of interest.

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Sharin, U.B.M., Hwang, C.C.J., Ang, W.H.D. et al. The haematopoietic stem cell transplant survivors’ sense of coherence about their experiences: a qualitative study. Support Care Cancer 28, 4275–4283 (2020).

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