Symptom clusters and sentinel symptoms during post-transplant recovery in recipients of allogeneic hematopoietic stem cell transplantation: A cross-sectional study.

Objective: This study explored symptom clusters and sentinel symptoms among recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT) during the recovery period, with the aim of identifying clustering patterns and establishing a clinical reference framework for early detection and management. Methods: A convenience sample of 209 hematologic oncology recipients who had completed allo-HSCT and were in the recovery phase, attending regular outpatient follow-up in China between December 2024 and March 2025, was recruited. Data were collected using a general information questionnaire and the Chinese version of the Memorial Symptom Assessment Scale. Symptom clusters were identified through exploratory factor analysis, and sentinel symptoms were determined via association analysis using the Apriori algorithm. Results: A total of 209 allo-HSCT recipients were included, with a median age of 39.6 years (interquartile range [IQR] 33.7-48.2) and a median time from diagnosis to transplantation of 6.0 months (IQR 4.8-9.8). During recovery, recipients reported a median of 5 symptoms (IQR 3-9), with a maximum of 18 concurrent symptoms. The most prevalent symptoms were lack of energy (56.5%), worrying (43.5%), and difficulty sleeping (42.1%), with median severity scores of 3.0 (IQR 1.0-4.0), 3.0 (IQR 1.0-4.0), and 2.0 (IQR 1.0-3.0), respectively. Exploratory factor analysis (Kaiser-Meyer-Olkin [KMO] ​= ​0.737; Bartlett's Conclusions: Recipients of allo-HSCT continue to experience diverse symptoms during recovery, which aggregate into distinct clusters. Importantly, three sentinel symptoms act as early indicators that markedly impair quality of life. Nurses should prioritize these sentinel symptoms as key intervention targets to guide precision nursing strategies, mitigate symptom progression, and improve clinical outcomes.