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Acute myeloid leukemia

Health-related quality of life, symptom burden, and comorbidity in long-term survivors of acute promyelocytic leukemia

Leukemia volume 33, pages 1598–1607 (2019)Cite this article

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Abstract

The objective of this study was to investigate health-related quality of life (HRQOL), symptom burden, and comorbidity profile in long-term acute promyelocytic leukemia (APL) survivors treated with standard chemotherapy. Overall, 307 long-term APL survivors were invited to participate. HRQOL was assessed with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and compared with that of age and sex-matched controls from the general population. Symptom burden was assessed with the MD Anderson Symptom Inventory (MDASI) questionnaire and comorbidity profile was also investigated. Median follow-up time since diagnosis was 14.3 years (interquartile range: 11.1–16.9 years). APL survivors had a statistically and clinically meaningful worse score for the role physical scale of the SF-36 (−9.5; 95% CI, −15.7 to −3.2, P = 0.003) than their peers in the general population. Fatigue was reported as moderate to severe by 29% of patients and 84.4% reported at least one comorbidity. Prevalence of comorbidity in APL survivors was higher than that reported by the general population. Also, marked variations were found in the HRQOL profile by number of comorbidities. Even many years after treatment ends, APL survivors treated with standard chemotherapy do not fully recover as they report HRQOL limitations and a substantial burden of symptoms.

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Acknowledgements

Part of the analyses reported in this article were based on data provided and licensed free of charge for scientific purposes by the Italian Institute of Statistics (ISTAT). However, ISTAT is not responsible neither for the analyses performed on its data nor for the corresponding results. All analyses, findings, and statements reported in this article are solely attributable to the authors and do not reflect the official policy or position of ISTAT. The authors are also grateful to Dr. Paola Mosconi from the Istituto di Ricerche Farmacologiche Mario Negri (Milan, Italy) for her support in getting access to the SF-36 Italian validation data. AIRC Grant IG15467 to FLC.

Author contributions

Conception and design: FE and FLC. Data analysis and interpretation: all authors. Statistical analysis: FC and FE. Manuscript writing: all authors. Final approval of manuscript: all authors.

Author information

Authors and Affiliations

  1. Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy

    Fabio Efficace, Francesco Cottone, Marco Vignetti & Sergio Amadori

  2. Department of Cellular Biotechnologies and Hematology, “Sapienza” University of Rome, Rome, Italy

    Massimo Breccia

  3. Hematology and Stem Cell Transplantation Unit, University Campus Bio-Medico, Rome, Italy

    Giuseppe Avvisati

  4. University of Milan, Hematology and BMT Unit, ASST Papa Giovanni XXIII, Bergamo, Italy

    Tamara Intermesoli

  5. Department of Hematology, ASST Spedali Civili, Brescia, Italy

    Erika Borlenghi

  6. Hematology Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy

    Paola Carluccio

  7. Hematology Project Foundation, Department of Hematology, San Bortolo Hospital, Vicenza, Italy

    Francesco Rodeghiero

  8. Division of Hematology and Bone Marrow Transplantation, Ospedali Riuniti Villa Sofia—Cervello, Palermo, Italy

    Francesco Fabbiano

  9. Department of Medical and Surgical Sciences Section of Hematology Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Modena, Italy

    Mario Luppi

  10. U.O. Ematologia e Centro TMO, Ospedale Armando Businco, Cagliari, Italy

    Claudio Romani

  11. Department of Hematology, Bone Marrow Transplant Center, Pescara, Italy

    Marco Sborgia

  12. Division of Hematology, Città della Salute e della Scienza Hospital, Turin, Italy

    Stefano D’Ardia

  13. Hematology Unit, Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy

    Francesco Nobile

  14. Hematology and Hematopoietic Transplantation Unit, San G. Moscati Hospital, Avellino, Italy

    Nicola Cantore

  15. Hematology, Parma University, Parma, Italy

    Monica Crugnola

  16. Department of Medicine, Section of Hematology, University of Verona, Verona, Italy

    Gianpaolo Nadali

  17. Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy

    Francesco Lo Coco

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  1. Fabio Efficace
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Correspondence to Fabio Efficace.

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Conflict of interest

FE: Consultancy (Seattle Genetics, Bristol-Myers Squibb, TEVA, Amgen, Orsenix, Incyte); Research funding (Lundbeck, TEVA and Amgen). GA: Honoraria (Teva, Takeda, Roche, Amgen, Jansen). MB: Honoraria for speaking (Novartis, Incyte, Pfizer, BMS). FLC: Consultancy (Orsenix and TEVA); Speakers Bureau (Novartis). The remaining authors declare that they have no conflict of interest.

Human investigations

The human investigations were performed after approval by a local Human Investigations Committee and in accordance with an assurance filed with and approved by the Department of Health and Human Services, where appropriate.

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This work was presented in part at the 58th American Society of Hematology (ASH) Annual Meeting in San Diego, CA in December 2016.

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Efficace, F., Breccia, M., Avvisati, G. et al. Health-related quality of life, symptom burden, and comorbidity in long-term survivors of acute promyelocytic leukemia. Leukemia 33, 1598–1607 (2019). https://doi.org/10.1038/s41375-018-0325-4

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