Quality of life in patients with acute myelogenous leukemia in prolonged first complete remission after bone marrow transplantation (allogeneic or autologous) or chemotherapy: a cross-sectional study of the EORTC-GIMEMA AML 8A trial

Abstract

Summary:vary from one study to another, they show generally a lower risk of relapse, and a longer disease-free survival (DFS) after AlloBMT and ABMT than after ICC. A cross-sectional study of quality of life (QOL) was performed in 98 patients in continued first complete From 1986 to 1992, the EORTC and GIMEMA Leukemia Cooperative Groups prospectively compared these remission (CR) for 1-7.4 years, after inclusion in the AML 8A trial which prospectively compared allogeneic three therapeutic options: patients with newly diagnosed AML were entered in the AML 8A trial, and, after the same bone marrow transplantation (AlloBMT), autologous BMT (ABMT) and intensive consolidation chemoinduction and intensive consolidation course, were assigned, according to availability of a family HLAtherapy. Several significant differences between the three treatment groups were observed, on the basis of matched donor or randomization, to AlloBMT, ABMT or a second ICC course. At a median follow-up time of 3.3 patient self-reports, with regard to somatic symptoms (mouth sores, cough, hair loss, headache), repeated years, there was a significantly longer DFS in the AlloBMT (55%) and ABMT (48%) arms than in the ICC arm (30%). 5 acute medical problems, physical functioning, role functioning, leisure activities and, above all, sexual funcHowever, the overall survival after CR was similar in the three arms, patients relapsing after ICC being more easily tioning. There were also significant differences for overall physical condition, and overall quality of life. For all salvaged and frequently receiving an ABMT during second CR. these parameters, the ranking was uniformly AlloBMT lower than ABMT lower than chemotherapy. These dif-The conclusions of this study were based on analyses made according to the intention-to-treat principle. In ferences remain significant after adjustment for time interval between CR and QOL evaluation, sex or age.addition, we have observed a significant difference with regard to the short-term toxicity of the treatment actually These results, confirming a higher risk of permanent impairment of QOL after BMT, may have an impact administered, the treatment-related mortality being 20, 10 and 6% after AlloBMT, ABMT and second ICC, respecton medical decisions and warrant further studies. Keywords: quality of life; acute myeloid leukemia; bone ively. Furthermore, the final results may also be hampered by long-term toxicity, especially due to the conditioning marrow transplantation regimens, with or without total body irradiation (TBI), for both BMT procedures, and to chronic graft-versus-host disease (GVHD) after AlloBMT. Such long-term somatic toxiAllogeneic bone marrow transplantation (AlloBMT), autocity is also likely to induce psychosocial sequelae. Indeed, logous bone marrow transplantation (ABMT), or intensive some previous studies have shown that quality of life consolidation chemotherapy (ICC) are currently proposed (QOL) might be more or less markedly impaired after for patients with acute myelogenous leukemia (AM...

Patient-reported quality of life after allogeneic hematopoietic cell transplantation or chemotherapy for acute leukemia

“…However, these results were conflicting, and few have controlled confounding backgrounds. [21][22][23][24][25][26][27] In a longitudinal study that assessed the QOL in patients treated with allo-HCT, autologous HCT or chemotherapy, the allo-HCT group had higher scores in global QOL, fatigue and sleep disturbance compared with the other two groups. 21 The results may be confounded by the difference in populations between the treatment groups: the allo-HCT group included only leukemia patients and the autologous HCT/chemotherapy groups included only lymphoma patients.…”

“…Three studies that included AML in remission reported worse QOL in patients who received Quality of life after treatment for acute leukemia S Kurosawa et al allo-HCT. 24,25,27 Zittoun et al 27 performed a cross-sectional study and showed that physical, role functioning, sexual functioning and overall QOL were significantly lower after allo-HCT than after chemotherapy. In more recent cross-sectional studies with a larger number of AML patients, allo-HCT had an adverse impact on the QOL in many of the dimensions in EORTC QLQ-C30.…”

“…In contrast, the EORTC QLQ-C30 was used in the three studies that reported a worse QOL in the allo-HCT group. 24,25,27 A study that compared the EORTC QLQ-C30 and the FACT-BMT indicated that these two measures showed a low correlation in emotional and social domains. 48 As the allo-HCT group in our study showed superior QOL especially in domains related to the mental state, this may partly account for the discrepancy between previous studies and ours.…”

“…[12][13][14][15][16][17][18][19][20] Several studies have compared patient-reported QOL between allo-HCT and chemotherapy. [21][22][23][24][25][26][27] Zittoun et al 27 performed a cross-sectional study of the EORTC-GIMEMA AML 8 A trial and compare QOL after allo-HCT, autologous HCT and chemotherapy, and reported that allo-HCT had an adverse impact on the QOL. More recent cross-sectional studies 24,25 applied the EORTC Quality of Life Core Questionnaire (QLQ-C30) to a larger number of AML patients, and reported that patients who received allo-HCT had a significantly worse QOL.…”

A single-centre assessment of long-term quality-of-life status after sibling allogeneic stem cell transplantation for chronic myeloid leukaemia in first chronic phase

“…They have been described previously. 22,23 The four questions asked about: (1) sexual interest, (2) activity, (3) pleasure and (4) ability on a three-way scale (increased, unchanged or decreased). One question on the Leukaemia-BMT (QLQ-LEU) module also dealt with pain during sexual intercourse.…”