PF276 QUALITY OF LIFE EVALUATION IN LONG TERM SURVIVORS WITH ACUTE MYELOID LEUKEMIA: A SINGLE CENTER EXPERIENCE
Authors: Tarantini F. , Carluccio P. , Carluccio V. , Delia M. , Attolico I. , Ricco A. , Mallano S. , Frappampina R. , Mestice A. , Impera L. , Albano F. , Specchia G. 
Published: June 2019

Background:

Acute Myeloid Leukemia is the most common acute leukemia in adults; median age at diagnosis is around 68 years. AML is cured in 35 to 40% of adult patients <65 yrs and in 5 to 15% of pts >70 yrs. The number of AML survivors is growing and is relevant the evaluation of health related quality of life associated with disease and treatment to propose potential strategies for intervention.

Aims:

We collected data on 382 AML adult pts (age<65 yrs) treated in our center. Of these, 77(20.2%) are long term survivors (LTS) (OS>5yrs). We evaluated the QoL of this subset of patients using the EORTC‐QLQ‐C30 questionnaire.

Methods:

From 2003 to 2013, 382 adult pts (age<65 yrs) were diagnosed with AML in our center. According to Revised Reccomendations (Cheson 2003) and ELN 2010 risk categories, 89 (23.3%) pts were at high risk, 215 (56.3%) intermediate and 78 (20.4%) low risk; 77 (20.2%)pts are long term survivors (OS>5 yrs). In this pts subset median age at diagnosis was 41.5 yrs (range 18–62). According to ELN 2010 risk categories only 7 (9%) were at HR, 36 (46.9%) IR and 34 (44.1%) LR; 42 (54.5%) pts underwent Allo‐HSCT, 13 (16.9%) Auto‐HSCT and 22 (28.6%) were treated with conventional consolidation regimens. OS was >5 yrs in 43 (55.8%) pts, and >10 yrs in 34 (44.2%).Our study included 35/77 (45,4%) randomly selected long term survivors;21(60%) underwent Allo‐HSCT, 8 (22.8%) Auto‐HSCT and 6 (17.2%) were treated with conventional CHT. Relapse occurred in 10 (28.6%) pts. Only 4 (11.4%) had “primary refractory” disease. 21/35 (60%) have an OS>5 yrs and 14/35 (40%) patients an OS>10 yrs. We compared data obtained from our sample to European reference values for the EORTC QLQ‐C30 questionnaire in order to establish factors affecting the QoL of LTS AML pts.

Results:

Global QoL of AML LTS pts is equal to that in the general population, but a reduction of all values in both functioning and symptoms scales is present. In the functioning scales minimum clinically significant differences (MCID:10 points) are present in the role, cognitive and social indexes. In the symptoms scales, insomnia, constipation and financial difficulties indexes reached the MCID. In order to establish which factors have a stronger impact on the QoL of AML pts, we stratified our sample considering these features: age at diagnosis (cut‐off: 55 years), Allo‐HSCT, OS>10 yrs. Age at diagnosis has an impact on symptoms scales: older patients have a clinically significant difference in fatigue, dyspnea and pain. QoL of younger pts is better but does not reach MCID. Pts who underwent Allo‐HSCT have a worse global QoL and clinically significant differences in symptoms scales, particularly dyspnea, pain, insomnia and fatigue. Pts with an OS>10 yrs have a global QoL and both functional and symptoms scales values equal to that of the general population (IMG 1). Differences in symptoms such as pain, fatigue, dyspnea, are present in patients with an OS<10 yrs.

Summary/Conclusion:

LTS AML pts are still a minority; with advances in therapeutic procedures they will hopefully grow. Therefore, QoL evaluation is a critical aspect to watch for. Our study suggests that age, disease characteristics and Allo‐HSCT have a strong impact on AML pts QoL. However, pts with an OS>10 years may be considered completely “cured” as their QoL values are equal to those in the general population. A final consideration should be made regarding the reintegration of AML pts in appropriate social and economic contexts, as financial difficulties were one of the most clinically significant values in all questionnaires.

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