Quality of Life in Elderly Patients with Acute Myeloid Leukemia.
Authors: Oliva Esther N. , Latagliata Roberto , Vincelli Iolanda , Specchia Giorgina , Ronco Francesca , Liso Vincenzo , Impera Stefana , Alati Caterina , Quota Alessandra , Alimena Giuliana , Breccia Massimo , Carmosino Ida , Fortugno Francesco , Nobile Francesco 
Published: October 2019

Abstract
Treatment of acute myeloid leukemia (AML) in elderly patients is generally tailored on the basis of age, performance status, concomitant diseases and patient consent. Toxicity and low-response rates are major constraints and therapeutic options are most likely conditioned by clinicians’ opinions rather than patient preferences. Health-related quality of life (HRQoL) may be useful in this setting. We designed a prospective multicenter study to evaluate the predictive potentials of HRQoL measures on prognosis in AML patients aged over 60 years. We present results in 95 patients of median age 72 (range 61–90) years. HRQoL was measured by the QOL-E and the EORTC QLQ-C30 questionnaires. Demographic and disease-related factors were also evaluated. The questionnaires showed good internal consistencies. Scores were low at baseline (reflecting poor HRQoL), particularly in the QOL-E fatigue (41.8), disease-specific (33.2) and treatment-related index (S_TOI=53.1) scales. Increasing age was correlated with concomitant diseases (r=0.256, p=0.012) and with EORTC global health (r=−0.217, p=0.041), QOL-E general/total (r=−0.239, p=0.022 / r=−0.247, p=0.019), physical function (QLQ-C30 r=−0.304, p=0.003; QOL-E r=−0.249, p=0.016), role function (QLQ-C30 r=−0.347, p=0.001), functional and fatigue (QLQ-C30 r=0.329, p=0.001; QOL-E r=−0.301, p=0.003) and QOL-E S_TOI (r=−0.281, p=0.007) scores. The presence of concomitant diseases was associated with poorer general health (p=0.019), physical well-being (p=0.011), role (p=0.026) and emotional function (=0.036). Baseline Hb levels correlated with fatigue, pain, dyspnea, insomnia, appetite loss and role function (QLQ-C30 p<0.001, p=0.013, p=0.013, p=0.021, p=0.010 and p=0.032, respectively) as well as functional, fatigue and total health (QOL-E p=0.024, p=0.002 and p=0.030, respectively). ECOG PS grades were associated with peripheral and bone marrow blasts (p=0.034 and p=0.042, respectively), with loss of appetite (EORTC p=0.024), and inversely with Hb levels (p=0.001) and QOL-E functional scores (p=0.014). After 1 month, 67 patients were alive for re-evaluation: decrease in QLQ-C30 physical functioning (delta=−9.096, p=0.019), role functional (delta=−17.836, p=0.002, but with increase at 6 months (delta=+15.385, p=0.032), cognitive function (p=0.035, with further decrease up to 12 months, p=0.014), and social function (delta=−11.111, p=0.019, but with an increase at 6 months (delta=+14.74, p=0.008) were observed. The fatigue score increased at one month (delta=+9.319, p=0.030) but decreased up to 12 months (delta=−6.837). Appetite loss improved at 6 months (delta=−15.55, p=0.024). Though QOL-E physical score decreased (p=0.002). there were significant relative increases in specific (p=0.006) and treatment outcome index (p=0.021) scores by month 12. In conclusion, HRQoL is poor at diagnosis, especially with increasing age and in patients with concomitant diseases, and it deteriorates during initial treatment. However, survivors at 6 and 12 months experience improvements in HRQoL, representing patients worth treating. HRQoL may indicate patient-tailored therapy in elderly AML patients.