Abstract
Background: Over the last decades, outcome from acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) has improved due to better treatment. However, little is still known about Quality of Life (QoL) of patients treated.
Methods: QoL was evaluated in patients who were randomized between April 2003 and September 2004 for treatment for AML and MDS in the German AMLCG99 trial at the university hospital of Munich-Grosshadern, Germany. QoL was evaluated using the EORTC QLQ-C30 questionnaire. During inhouse and out-patient treatment, QoL was evaluated at eight consecutive time points. Besides leukemia-specific data, duration of inhouse treatment, duration of leukocytopenia and maximal c-reactive protein (CRP max), hemoglobine levels were evaluated. QoL results were compared to already published data from normal German population and patients with small cell lung cancer.
Results: In total, 57 patients were treated, of which 76,3% had a de-novo AML, 20,3% a secondary AML and two patients an MDS. Median event-free survival was 15,4 months.
QoL data from 49 patients, who filled in a total number of 238 QLQ-C30 questionnaires, was available for analysis. Ten patients received allogeneic stem cell or bone marrow transplantation (BMT) instead of cyclic maintainance therapy.
Scores for global health status were low in the beginning, but improved significantly during treatment, finally reaching levels, that were not significantly different from normal population. No differences were seen for patients who subsequently went off protocol due to relapse or death, for karyotype or initial lactate dehydrogenases (LDH). There were neither any differences in between age groups, induction therapy groups, for patients receiving g-csf priming and those who did not or in between older patients receiving a 2nd induction chemotherapy and those who did not. Global health status did not correlate with duation of inhouse treatment, with duration of Leukocytopenia or CRP max.
Physical functioning and fatigue mainly accounted for global health status and were correlating with other functional and symptome scores. However, hemoglobin levels did not show high correlation with physical functioning or fatigue. Social functioning was significantly better for older patients (60 years and older) at the end of treatment than it was for younger ones. BMT was worsening physical and social functioning at the end of inpatient treatment, however, differences disappeared during further evaluation of QoL.
Conclusion: Rather because of than despite treatment, patient’s QoL was improving during time, partially even reaching levels of normal population.
Parameters detected by geriatric and quality of life assessment in 195 older patients with myelodysplastic syndromes and acute myeloid leukemia are highly predictive for outcome