Factors Influencing Quality of Life in Children with Hematopoietic Stem Cell Transplantation: a Systematic Review postprint

Abstract: Background　Hematopoietic stem cell transplantation (HSCT) is a critical treatment for pediatric hematological and immunological diseases. With the extension of patient survival, quality of life (QoL) has emerged as a key indicator for evaluating transplantation outcomes. Although previous studies have explored the factors influencing QoL in children undergoing HSCT, findings remain inconsistent. Objective　To systematically evaluate the factors affecting QoL in pediatric patients following HSCT. Methods　This study was conducted following the PRISMA 2020 statement. A computerized search was performed in PubMed, Web of Science, Embase, CINAHL, CNKI, Wanfang Data, VIP, and CBM databases from inception to January 7, 2026, to identify studies on factors influencing QoL in pediatric HSCT recipients. Two researchers independently performed literature screening, data extraction, and quality assessment. Descriptive analysis was used to summarize all identified factors. For factors with sufficient data for pooling, a meta-analysis was performed using R software (version 4.5.0). Evidence quality was graded using the GRADE system. Results　A total of 25 studies involving 2,534 participants were included, and 31 influencing factors were identified. Descriptive analysis showed consistent findings for 20 factors, while 11 factors remained controversial. Pooled results from the subgroup meta-analysis indicated that patient age (r=-0.20, 95%CI=-0.31 to -0.09), disease diagnosis (r=-0.29, 95%CI=-0.36 to -0.22), and donor type (r=-0.30, 95%CI=-0.48 to -0.08) were negatively correlated with QoL in pediatric HSCT patients. Conversely, maternal education level (r=0.27, 95%CI=0.06 to 0.45) and time since transplantation (r=0.42, 95%CI=0.18 to 0.62) were positively correlated with QoL (P<0.05). However, in the multivariate subgroup analysis, maternal education level and time since transplantation showed no significant correlation with QoL (P>0.05). Meta-analysis of multivariate results revealed that parental emotional functioning (r=0.47, 95%CI=0.41 to 0.53) was positively correlated with QoL, while chronic graft-versus-host disease (cGVHD) (r=-0.16, 95%CI=-0.24 to -0.09) and complications (r=-0.49, 95%CI=-0.74 to -0.12) were negatively correlated (P<0.05). Conclusion　Older age, malignant diagnosis, unrelated donor, cGVHD, and complications are risk factors for impaired QoL in pediatric HSCT recipients, whereas favorable parental emotional functioning is a protective factor. These findings require further validation through large-scale, high-quality prospective studies.