The impact of high-dose chemotherapy, autologous stem cell transplant and conventional chemotherapy on quality of life of long-term survivors with follicular lymphoma

Abstract

In this study we investigated the quality of life (QoL) of long-term survivors with follicular lymphoma (FL) after high-dose chemotherapy (HDCT) and autologous stem cell transplant (ASCT) using two standardized questionnaires. Altogether, 124 patients with FL were included in the study. A total of 63 patients received HDCT with ASCT, and this group was compared with 61 patients who were treated with rituximab and CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy and supplementary radiation. In addition, the QoL of the patients was compared to the QoL of healthy people on the basis of two studies about the general health status of the German population. When the QoLs of the HDCT group and the conventional therapy group were compared, there was a tendency for better QoL in the HDCT group, maybe due to a higher proportion of patients in complete remission (CR) or a longer follow-up period in the HDCT group (8.5 years vs. 4.5 years in the conventional therapy group). In both the HDCT group and the conventional therapy group, the results of the questionnaires showed a reduced QoL compared to the healthy population. In this study, there was a tendency for better QoL in the HDCT group compared to the conventional therapy group. However, the negative impact of both HDCT and conventional therapy on the QoL of patients with follicular lymphoma should not be underestimated and should lead to the development of less toxic therapy strategies.

The Myeloma Patient Outcome Scale is the first quality of life tool developed for clinical use and validated in patients with follicular lymphoma

“…MyPOS performs well as a tool for differentiating between patient groups. In line with existing evidence, patients with lower performance status and those on active treatment had worse symptoms and function . Total MyPOS and MyPOS subscale scores also behaved as expected against existing validated measures, the FACT‐LYM and EORTC‐QLQ‐C30.…”

“…Although the MyPOS was originally developed for use in patients with myeloma, similarities between the two diseases and a lack of FL‐specific tools, led us to validate the MyPOS in FL. Fatigue, pain, constipation, peripheral neuropathy, dyspnoea, sleep problems, sexual dysfunction, reduced physical and social functioning, and financial problems are common across both patient groups . The successful validation of MyPOS in FL supports further development and validation of the tool for use in other indolent NHL conditions and chronic haematological malignancies such as CLL and CML.…”

“…Active monitoring for patients with low disease burden is a common strategy but is associated with anxiety as patients anticipate inevitable progression of the disease . Moreover, because of the increase in survival, long‐term effects of therapy accumulate, among them toxicity‐related symptoms, persistent fatigue, depression and anxiety . These long‐term effects have been shown in a recent systematic review to impact all dimensions of health‐related quality of life (HRQOL) even at more than 5 years post‐diagnosis …”

“…Despite these long‐term effects, research on HRQOL in NHL and FL patients is lacking. Only four studies so far have specifically focused on FL patients, documenting the effect of different modes of treatment on return to work and emotional well‐being . Two systematic reviews of HRQOL in NHL present overall results for this group of haematological cancer patients .…”

1st World Congress on Controversies in Multiple Myeloma (COMy) Bangkok, May 11-13 2014

“…Dans une etude de 1998 [33], il a et e montr e que, a SG identique, la qualit e de vie etait meilleure dans le groupe autogreffe en premi ere ligne (versus autogreffe tardive) (en lien avec la p eriode de temps sans symptôme, sans traitement et avec la toxicit e des traitements) [34,35]. De plus, une autogreffe peut ne plusêtre r ealisable tardivement en raison du caract ere r efractaire de la maladie, de la d et erioration du PS et/ou des comorbidit es.…”