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Ineligibility for Intensive Chemotherapy Impacts QoL Scores, Survival in AML

David Bai, PharmD
Patients with acute myeloid leukemia (AML) who are ineligible for intensive chemotherapy tend to have poor health-related quality of life (HRQoL) scores that are independent predictors of poor survival, a recent study reported.
According to the results of a recent study, patients with acute myeloid leukemia (AML) who are ineligible for intensive chemotherapy tend to have poor health-related quality of life (HRQoL) scores that are independent predictors of poor survival.

AML is an aggressive disease with a poor prognosis and a 5-year survival of 26%. Treatments for AML are typically divided between intensive chemotherapy and nonintensive chemotherapy. For patients who are younger than 60, treatments are generally intensive and consist of the “7+3” regimen, 7 days of treatment with cytarabine and 3 days of treatment with an anthracycline. For patients who are older than 70, treatments are nonintensive and include hypomethylating agents and best supportive care.

The median age for AML is 68, indicating that many of these patients will be ineligible to receive intensive chemotherapy. However, the HRQoL of the patients has not been evaluated for this patient population. In this study, investigators reported on the HRQoL among patients with AML not eligible for intensive chemotherapy.

Investigators extracted data from 12 original studies. Most of the studies utilized the EORTC QLQ-C30 and 5 studies reported EQ-5D values. Other scales used included FACT, Hospital Anxiety and Depression Scale, and global fatigue scale. Data from the 4 original randomized controlled trials indicated that nonintensive chemotherapy achieved meaningful improvements in the fatigue and global health status of EORTC QLQ-C30. In 1 prospective study, patients treated with azacitidine who responded had significantly superior EQ-5D scores as well as lower FACIT-fatigue scores compared with patients who did not respond to therapy. In another prospective study, patients treated with nonintensive chemotherapy had significantly improved physical function and fatigue scores in the EROTC QLQ-C30.

HRQoL also correlates with overall survival (OS). Patients with low initial scores at diagnosis had much shorter survival compared with patients with higher scores. Fatigue and distress were the symptoms most reported. Some of the scores that were found to be lower were physical functioning, role function, and fatigue scores. Scores were especially better for patients with first-line disease than patients who with refractory or relapsed disease.

Compared with the general population, patients with AML had more fatigue, pain, dyspnea, and appetite loss. Based on a 0-100 scale, with lower scores indicating poorer health, patients with AML on nonintensive chemotherapy had low baseline HRQoL scores, particularly in fatigue (33) and global health status (50). In the 1 cost-effective analysis that was included in this report, investigators found patients receiving a hypomethylating agent had better quality of life than patients receiving best supportive care. Transfusion dependency was also a factor related to HRQoL assessments.

Patient reported outcomes such as HRQoL has become an important assessment tool in accounting for treatment objectives to that the patient finds important. Because many of these quality of life measures are independent prognostic factors for OS, trials should account for these measures to evaluate treatment impacts in a patient’s life.

Reference

Forsythe A, Kwon CS, Bell T, Smith TA, Arondekar B. Health-related quality of life in acute myeloid leukemia patients not eligible for intensive chemotherapy: results of a systematic literature review. Clincoecon Outcome Res. 2019;11:87-98. doi://10.2147/CEOR.S187409.

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