Comparison of Symptom Burden in Acute Myeloid Leukemia (AML) and Myelodysplastic Syndrome (MDS)
Authors: Williams Loretta A. , Ahaneku Hycienth , Cortes Jorge E. , Garcia Manero Guillermo , Kantarjian Hagop M. , Shi Qiuling , Lin Huei-Kai , Limaye Achala R. , Cleeland Charles S. 
Published: November 2019

Abstract
Objective: Patient report of symptom burden from acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) is scarce. Symptom burden is the combined impact of symptoms from disease and treatment on daily functioning. We are developing a measure of symptom burden in AML and MDS. The purpose of this interim analysis is to compare the symptom burden of patients with AML and MDS.
Methods: Patients with AML or MDS rated the 13 core symptom items, 6 proposed AML/MDS-specific symptom items, and 6 interference items of the MD Anderson Symptom Inventory on a 0-10 scale (0 = not present or no interference; 10 = as bad as can be imagined or complete interference). Patient clinical and demographic information was collected from medical records. The symptom burden of AML/MDS was determined and compared using descriptive statistics and t-tests.
Results: Mean ages of the 45 AML patients and 48 MDS patients were 62.4 (standard deviation [SD] = 11.3) and 68.5 years (SD = 9.2; p = 0.005), respectively; 61% and 60% (p = not significant), respectively, were male; 76% and 92% (p = 0.043), respectively, were white. The composite mean severity score of the core symptom items was 2.75 (SD = 1.58) and 1.84 (SD = 1.52; p = 0.006), the composite mean of the AML/MDS specific items was 2.51 (SD = 1.87) and 1.49 (1.60; p = 0.005), and the composite mean score of the interference items was 3.96 (SD = 2.72) and 2.81 (SD = 2.69; p = 0.042) for the AML and MDS patients, respectively. The means, ranks, significance of difference in ratings, and prevalence of the individual symptom and interference items for the AML and MDS patients are in Table 1. Cronbach α for all symptom items was 0.94 and for all interference items was 0.92.
Conclusions: Patients with AML and MDS experience similar symptoms. However, patients with AML report significantly more severe pain, fatigue, nausea, lack of appetite, dry mouth, vomiting, fever, and headache than patients with MDS. Only prevalence of shortness of breath and diarrhea was higher in MDS patients, but there was no difference in reported mean severity of these symptoms. Except for general activity, rating of symptom interference with daily activities is similar for the two groups. Lack of recognition of symptoms experienced by patients with AML and MDS can lead to inadequate management of symptoms, interfere with patients' ability to function and enjoy life, and impact the tolerability of and adherence to treatment regimens. Validation of this measure of symptom burden for patients with AML and MDS to allow more accurate and consistent monitoring of symptoms by clinicians and in clinical research is ongoing.
Table 1. Individual MDASI Item Means and Significance for AML and MDS Patients Core Symptom Items N Mean SD p-value Rank Prevalence (%) Pain MDS 48 2.00 2.760 0.009* 9 58 AML 45 3.69 3.309 3 69 Fatigue MDS 47 3.45 2.947 0.037* 1 79 AML 45 4.69 2.653 1 91 Nausea MDS 48 .50 1.368 <0.001* 17 23 AML 45 2.67 3.233 9 58 Disturbed Sleep MDS 48 2.38 3.050 0.124 4 56 AML 45 3.38 3.172 7 71 Distress MDS 48 2.19 2.498 0.476 7 63 AML 45 2.56 2.455 10 71 Shortness of Breath MDS 48 2.15 2.518 0.543 8 65 AML 45 1.84 2.215 17 53 Problems Remembering MDS 48 1.94 2.025 0.663 10 71 AML 45 2.13 2.292 14 71 Lack of Appetite MDS 48 1.33 2.035 <0.001* 13 48 AML 45 3.73 3.460 2 76 Drowsiness MDS 48 2.85 3.032 0.187 2 71 AML 45 3.69 3.021 3 78 Dry Mouth MDS 48 2.31 2.746 0.045* 6 69 AML 44 3.59 3.223 5 73 Sadness MDS 48 1.83 2.127 0.394 11 60 AML 45 2.22 2.255 11 73 Vomiting MDS 48 0.00 0.000 0.009* 19 0 AML 45 .73 1.912 19 22 Numbness or Tingling MDS 48 1.08 2.071 .712 15 33 AML 45 .93 1.814 18 33 AML/MDS-Specific Symptom Items Malaise MDS 48 2.46 2.843 0.133 3 65 AML 46 3.35 2.838 8 78 Fever MDS 48 .50 1.544 0.006* 18 19 AML 46 1.91 3.002 16 41 Headache MDS 48 .81 1.483 0.011* 16 35 AML 46 2.22 3.339 11 44 Diarrhea MDS 48 1.56 2.567 0.512 12 48 AML 46 1.96 3.211 15 41 Muscle Weakness MDS 48 2.35 2.899 0.063 5 60 AML 46 3.43 2.664 6 83 Rash or Skin Problems MDS 48 1.23 2.469 0.065 14 38 AML 46 2.22 2.666 11 59 Interference Items General Activity MDS 46 3.20 3.449 0.031* 3 65 AML 46 4.83 3.696 2 80 Mood MDS 48 2.38 2.687 0.066 5 65 AML 44 3.48 2.984 5 80 Work MDS 48 3.54 3.638 0.086 1 67 AML 46 4.87 3.781 1 78 Relations with Others MDS 48 1.69 2.683 0.154 6 48 AML 46 2.54 3.082 6 52 Walking MDS 48 2.88 3.112 0.275 4 71 AML 46 3.57 2.971 4 78 Enjoyment of Life MDS 48 3.21 3.261 0.055 2 73 AML 46 4.54 3.397 3 80
* Significant at p < 0.05.

Disclosures
No relevant conflicts of interest to declare.