The anemia-independent impact of myelodysplastic syndromes on health-related quality of life.
Anemia
Health-related quality of life
Hemoglobin
Myelodysplastic syndromes
Journal
Annals of hematology
ISSN: 1432-0584
Titre abrégé: Ann Hematol
Pays: Germany
ID NLM: 9107334
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
received:
04
03
2021
accepted:
24
08
2021
pubmed:
4
9
2021
medline:
15
12
2021
entrez:
3
9
2021
Statut:
ppublish
Résumé
Myelodysplastic syndromes (MDS) are in the majority of cases characterized by anemia. Both anemia and MDS per se may directly contribute to impairments in health-related quality of life (HRQoL). In this study, we aimed to investigate the anemia-independent impact of MDS on HRQoL. We evaluated participants (≥ 50 years) from the large population-based Lifelines cohort (N = 44,694, mean age 59.0 ± 7.4 years, 43.6% male) and the European MDS Registry (EUMDS) (N = 1538, mean age 73.4 ± 9.0 years, 63.0% male), which comprises a cohort of lower-risk MDS patients. To enable comparison concerning HRQoL, SF-36 scores measured in Lifelines were converted to EQ-5D-3L index (range 0-1) and dimension scores. Lower-risk MDS patients had significantly lower HRQoL than those from the Lifelines cohort, as illustrated in both the index score and in the five different dimensions. Multivariable linear regression analysis demonstrated that MDS had an adjusted total impact on the EQ-5D index score (B = - 0.12, p < 0.001) and an anemia-independent "direct" impact (B = - 0.10, p < 0.001). Multivariable logistic regression analysis revealed an anemia-independent impact of MDS in the dimension mobility, self-care, usual activities, and anxiety/depression (all except pain/discomfort). This study demonstrates that the major part of the negative impact of lower-risk MDS on HRQoL is not mediated via anemia. Thus, the therapeutic focus should include treatment strategies directed at underlying pathogenic mechanisms to improve HRQoL, rather than aiming predominantly at increasing hemoglobin levels.
Identifiants
pubmed: 34476573
doi: 10.1007/s00277-021-04654-1
pii: 10.1007/s00277-021-04654-1
pmc: PMC8592948
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2921-2932Informations de copyright
© 2021. The Author(s).
Références
Malcovati L, Hellstrom-Lindberg E, Bowen D et al (2013) Diagnosis and treatment of primary myelodysplastic syndromes in adults: recommendations from the European LeukemiaNet. Blood 122:2943–2964. https://doi.org/10.1182/blood-2013-03-492884
doi: 10.1182/blood-2013-03-492884
pubmed: 23980065
pmcid: 3811170
Santini V (2015) Anemia as the main manifestation of myelodysplastic syndromes. Semin Hematol 52:348–356. https://doi.org/10.1053/j.seminhematol.2015.06.002
doi: 10.1053/j.seminhematol.2015.06.002
pubmed: 26404446
Abel GA, Buckstein R (2016) Integrating frailty, comorbidity, and quality of life in the management of myelodysplastic syndromes. Am Soc Clin Oncol Educ Book 35:e337-344. https://doi.org/10.1200/EDBK_158639
doi: 10.1200/EDBK_158639
pubmed: 27249740
de Swart L, Smith A, Johnston TW et al (2015) Validation of the revised international prognostic scoring system (IPSS-R) in patients with lower-risk myelodysplastic syndromes: a report from the prospective European LeukaemiaNet MDS (EUMDS) registry. Br J Haematol 170:372–383. https://doi.org/10.1111/bjh.13450
doi: 10.1111/bjh.13450
pubmed: 25907546
Stauder R, Yu G, Koinig KA et al (2018) Health-related quality of life in lower-risk MDS patients compared with age- and sex-matched reference populations: a European LeukemiaNet study. Leukemia 32:1380–1392. https://doi.org/10.1038/s41375-018-0089-x
doi: 10.1038/s41375-018-0089-x
pubmed: 29572506
pmcid: 5990524
Greenberg P, Cox C, LeBeau MM et al (1997) International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood 89:2079–2088
doi: 10.1182/blood.V89.6.2079
pubmed: 9058730
Greenberg PL, Tuechler H, Schanz J et al (2012) Revised international prognostic scoring system for myelodysplastic syndromes. Blood 120:2454–2465. https://doi.org/10.1182/blood-2012-03-420489
doi: 10.1182/blood-2012-03-420489
pubmed: 22740453
pmcid: 4425443
Montalban-Bravo G, Garcia-Manero G (2018) Myelodysplastic syndromes: 2018 update on diagnosis, risk-stratification and management. Am J Hematol 93:129–147. https://doi.org/10.1002/ajh.24930
doi: 10.1002/ajh.24930
pubmed: 29214694
Rochau U, Stojkov I, Conrads-Frank A et al (2020) Development of a core outcome set for myelodysplastic syndromes - a Delphi study from the EUMDS Registry Group. Br J Haematol 191:405–417. https://doi.org/10.1111/bjh.16654
doi: 10.1111/bjh.16654
pubmed: 32410281
pmcid: 8221029
Wouters HJ, van der Klauw MM, de Witte T et al (2019) Association of anemia with health-related quality of life and survival: a large population-based cohort study. Haematologica 104:468–476. https://doi.org/10.3324/haematol.2018.195552
doi: 10.3324/haematol.2018.195552
pubmed: 30309850
pmcid: 6395328
Platzbecker U, Hofbauer LC, Ehninger G, Hölig K (2012) The clinical, quality of life, and economic consequences of chronic anemia and transfusion support in patients with myelodysplastic syndromes. Leuk Res 36:525–536. https://doi.org/10.1016/j.leukres.2012.01.006
doi: 10.1016/j.leukres.2012.01.006
pubmed: 22300879
Steensma DP, Heptinstall KV, Johnson VM et al (2008) Common troublesome symptoms and their impact on quality of life in patients with myelodysplastic syndromes (MDS): results of a large internet-based survey. Leuk Res 32:691–698. https://doi.org/10.1016/j.leukres.2007.10.015
doi: 10.1016/j.leukres.2007.10.015
pubmed: 18054795
Efficace F, Gaidano G, Breccia M et al (2015) Prevalence, severity and correlates of fatigue in newly diagnosed patients with myelodysplastic syndromes. Br J Haematol 168:361–370. https://doi.org/10.1111/bjh.13138
doi: 10.1111/bjh.13138
pubmed: 25272332
Oliva EN, Dimitrov BD, Benedetto F, D’Angelo A, Nobile F (2005) Hemoglobin level threshold for cardiac remodeling and quality of life in myelodysplastic syndrome. Leuk Res 29:1217–1219. https://doi.org/10.1016/j.leukres.2005.03.004
doi: 10.1016/j.leukres.2005.03.004
pubmed: 16111537
Jansen AJ, Essink-Bot ML, Beckers EA, Hop WC, Schipperus MR, Van Rhenen DJ (2003) Quality of life measurement in patients with transfusion-dependent myelodysplastic syndromes. Br J Haematol 121:270–274. https://doi.org/10.1046/j.1365-2141.2003.04272.x
doi: 10.1046/j.1365-2141.2003.04272.x
pubmed: 12694248
Casadevall N, Durieux P, Dubois S et al (2004) Health, economic, and quality-of-life effects of erythropoietin and granulocyte colony-stimulating factor for the treatment of myelodysplastic syndromes: a randomized, controlled trial. Blood 104:321–327. https://doi.org/10.1182/blood-2003-07-2252
doi: 10.1182/blood-2003-07-2252
pubmed: 15054036
Platzbecker U, Symeonidis A, Oliva EN et al (2017) A phase 3 randomized placebo-controlled trial of darbepoetin alfa in patients with anemia and lower-risk myelodysplastic syndromes. Leukemia 31:1944–1950. https://doi.org/10.1038/leu.2017.192
doi: 10.1038/leu.2017.192
pubmed: 28626220
pmcid: 5596208
Stauder R, Augschoell J, Hamaker ME, Koinig KA (2020) Malnutrition in older patients with hematological malignancies at initial diagnosis - association with impairments in health status, systemic inflammation and adverse outcome. Hemasphere 4(1):e332. https://doi.org/10.1097/HS9.0000000000000332
doi: 10.1097/HS9.0000000000000332
pubmed: 32072148
pmcid: 7000469
Scholtens S, Smidt N, Swertz MA et al (2015) Cohort Profile: LifeLines, a three-generation cohort study and biobank. Int J Epidemiol 44:1172–1180. https://doi.org/10.1093/ije/dyu229
doi: 10.1093/ije/dyu229
pubmed: 25502107
Stolk RP, Rosmalen JG, Postma DS et al (2008) Universal risk factors for multifactorial diseases: LifeLines: a three-generation population-based study. Eur J Epidemiol 23:67–74. https://doi.org/10.1007/s10654-007-9204-4
doi: 10.1007/s10654-007-9204-4
pubmed: 18075776
Sorror ML, Maris MB, Storb R et al (2005) Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 106:2912–2919. https://doi.org/10.1182/blood-2005-05-2004
doi: 10.1182/blood-2005-05-2004
pubmed: 15994282
pmcid: 1895304
Sorror ML, Sandmaier BM, Storer BE et al (2007) Comorbidity and disease status based risk stratification of outcomes among patients with acute myeloid leukemia or myelodysplasia receiving allogeneic hematopoietic cell transplantation. J Clin Oncol 25:4246–4254. https://doi.org/10.1200/JCO.2006.09.7865
doi: 10.1200/JCO.2006.09.7865
pubmed: 17724349
Della Porta MG, Malcovati L, Strupp C et al (2010) Risk stratification based on both disease status and extra-hematologic comorbidities in patients with myelodysplastic syndrome. Haematologica 96:441–449. https://doi.org/10.3324/haematol.2010.033506
doi: 10.3324/haematol.2010.033506
pubmed: 21134982
pmcid: 3046276
Klijs B, Scholtens S, Mandemakers JJ, Snieder H, Stolk RP, Smidt N (2015) Representativeness of the LifeLines Cohort Study. PLoS ONE 10(9):e0137203. https://doi.org/10.1371/journal.pone.0137203
doi: 10.1371/journal.pone.0137203
pubmed: 26333164
pmcid: 4557968
Brooks R (1996) EuroQol: the current state of play. Health Policy 37:53–72. https://doi.org/10.1016/0168-8510(96)00822-6
doi: 10.1016/0168-8510(96)00822-6
pubmed: 10158943
Greiner W, Weijnen T, Nieuwenhuizen M et al (2003) A single European currency for EQ-5D health states. Results from a six-country study. Eur J Health Econ 4:222–231. https://doi.org/10.1007/s10198-003-0182-5
doi: 10.1007/s10198-003-0182-5
pubmed: 15609189
Dolan P (1997) Modeling Valuations for EuroQol Health States. Med Care 35:1095–1111. https://doi.org/10.1097/00005650-199711000-00002
doi: 10.1097/00005650-199711000-00002
pubmed: 9366889
VanderZee KI, Sanderman R, Heyink JW, de Haes H (1996) Psychometric qualities of the RAND 36-Item Health Survey 1.0: a multidimensional measure of general health status. Int J Behav Med 3:104–122. https://doi.org/10.1207/s15327558ijbm0302_2
doi: 10.1207/s15327558ijbm0302_2
pubmed: 16250758
Ware J, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233. https://doi.org/10.1097/00005650-199603000-00003
doi: 10.1097/00005650-199603000-00003
pubmed: 8628042
Rowen D, Brazier J, Roberts J (2009) Mapping SF-36 onto the EQ-5D index: how reliable is the relationship? Health Qual Life Outcomes 7:27. https://doi.org/10.1186/1477-7525-7-27
doi: 10.1186/1477-7525-7-27
pubmed: 19335878
pmcid: 2683169
Gray AM, Rivero-Arias O, Clarke PM (2006) Estimating the association between SF-12 responses and EQ-5D utility values by response mapping. Med Decis Making 26:18–29. https://doi.org/10.1177/0272989X05284108
doi: 10.1177/0272989X05284108
pubmed: 16495197
Blanc B, Finch CA, Hallberg L et al (1968) Nutritional anaemias. Report of a WHO scientific group. World Health Organ Tech Rep Ser 405:5–37
Cox E, Martin BC, Van Staa T et al (2009) Good research practices for comparative effectiveness research: approaches to mitigate bias and confounding in the design of nonrandomized studies of treatment effects using secondary data sources: the international society for pharmacoeconomics and outcomes research good research practices for retrospective database analysis task force report–part II. Value Health 12:1053–1061. https://doi.org/10.1111/j.1524-4733.2009.00601.x
doi: 10.1111/j.1524-4733.2009.00601.x
pubmed: 19744292
Efficace F, Cottone F, Oswald LB et al (2020) The IPSS-R more accurately captures fatigue severity of newly diagnosed patients with myelodysplastic syndromes compared with the IPSS index. Leukemia 34:2451–2459. https://doi.org/10.1038/s41375-020-0746-8
doi: 10.1038/s41375-020-0746-8
pubmed: 32086447
pmcid: 7509847
Vestergaard S, Nayfield SG, Patel KV et al (2009) Fatigue in a representative population of older persons and its association with functional impairment, functional limitation, and disability. J Gerontol A Biol Sci Med Sci 64(1):76–82. https://doi.org/10.1093/gerona/gln017
doi: 10.1093/gerona/gln017
pubmed: 19176328
Linden W, Vodermaier A, Mackenzie R, Greig D (2012) Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age. J Affect Disord 141:343–351. https://doi.org/10.1016/j.jad.2012.03.025
doi: 10.1016/j.jad.2012.03.025
pubmed: 22727334
Stauder R, Lambert J, Desruol-Allardin S et al (2020) Patient-reported outcome measures in studies of myelodysplastic syndromes and acute myeloid leukemia: literature review and landscape analysis. Eur J Haematol 104:476–487. https://doi.org/10.1111/ejh.13389
doi: 10.1111/ejh.13389
pubmed: 31985078
pmcid: 7217037
Hellström-Lindberg E, Gulbrandsen N, Lindberg G et al (2003) A validated decision model for treating the anaemia of myelodysplastic syndromes with erythropoietin + granulocyte colony-stimulating factor: significant effects on quality of life. Br J Haematol 120:1037–1046. https://doi.org/10.1046/j.1365-2141.2003.04153.x
doi: 10.1046/j.1365-2141.2003.04153.x
pubmed: 12648074
Banerjee T, Calvi LM, Becker MW, Liesveld JL (2019) Flaming and fanning: the spectrum of inflammatory influences in myelodysplastic syndromes. Blood Rev 36:57–69. https://doi.org/10.1016/j.blre.2019.04.004
doi: 10.1016/j.blre.2019.04.004
pubmed: 31036385
pmcid: 6711159
Shi X, Zheng Y, Xu L, Cao C, Dong B, Chen X (2019) The inflammatory cytokine profile of myelodysplastic syndromes: a meta-analysis. Medicine (Baltimore) 98(22):e15844. https://doi.org/10.1097/MD.0000000000015844
doi: 10.1097/MD.0000000000015844
Cohen HJ, Pieper CF, Harris T, Rao KM, Currie MS (1997) The association of plasma IL-6 levels with functional disability in community-dwelling elderly. J Gerontol A Biol Sci Med Sci 52:M201-208. https://doi.org/10.1093/gerona/52a.4.m201
doi: 10.1093/gerona/52a.4.m201
pubmed: 9224431
Christian LM, Glaser R, Porter K, Malarkey WB, Beversdorf D, Kiecolt-Glaser JK (2011) Poorer self-rated health is associated with elevated inflammatory markers among older adults. Psychoneuroendocrinology 36:1495–1504. https://doi.org/10.1016/j.psyneuen.2011.04.003
doi: 10.1016/j.psyneuen.2011.04.003
pubmed: 21601365
pmcid: 3161147
Tait JL, Duckham RL, Milte CM, Main LC, Daly RM (2019) Associations between inflammatory and neurological markers with quality of life and well-being in older adults. Exp Gerontol 125:110662. https://doi.org/10.1016/j.exger.2019.110662
doi: 10.1016/j.exger.2019.110662
pubmed: 31323254
Nowakowski AC (2014) Chronic inflammation and quality of life in older adults: a cross-sectional study using biomarkers to predict emotional and relational outcomes. Health Qual Life Outcomes 12:141. https://doi.org/10.1186/s12955-014-0141-0
doi: 10.1186/s12955-014-0141-0
pubmed: 25260501
pmcid: 4189208
Jylhä M, Volpato S, Guralnik JM (2006) Self-rated health showed a graded association with frequently used biomarkers in a large population sample. J Clin Epidemiol 59:465–471. https://doi.org/10.1016/j.jclinepi.2005.12.004
doi: 10.1016/j.jclinepi.2005.12.004
pubmed: 16632134
Meyers CA, Albitar M, Estey E (2005) Cognitive impairment, fatigue, and cytokine levels in patients with acute myelogenous leukemia or myelodysplastic syndrome. Cancer 104:788–793. https://doi.org/10.1002/cncr.21234
doi: 10.1002/cncr.21234
pubmed: 15973668
Cluzeau T, McGraw KL, Irvine B et al (2017) Pro-inflammatory proteins S100A9 and tumor necrosis factor-α suppress erythropoietin elaboration in myelodysplastic syndromes. Haematologica 102:2015–2020. https://doi.org/10.3324/haematol.2016.158857
doi: 10.3324/haematol.2016.158857
pubmed: 28983059
pmcid: 5709100
Kotla V, Goel S, Nischal S et al (2009) Mechanism of action of lenalidomide in hematological malignancies. J Hematol Oncol 2:36. https://doi.org/10.1186/1756-8722-2-36
doi: 10.1186/1756-8722-2-36
pubmed: 19674465
pmcid: 2736171
Santini V, Almeida A, Giagounidis A et al (2018) The effect of lenalidomide on health-related quality of life in patients with lower-risk non-del(5q) myelodysplastic syndromes: results from the MDS-005 study. Clin Lymphoma Myeloma Leuk 18:136-144.e7. https://doi.org/10.1186/1756-8722-2-36
doi: 10.1186/1756-8722-2-36
pubmed: 29429612
Revicki DA, Brandenburg NA, Muus P, Yu R, Knight R, Fenaux P (2013) Health-related quality of life outcomes of lenalidomide in transfusion-dependent patients with Low- or Intermediate-1-risk myelodysplastic syndromes with a chromosome 5q deletion: results from a randomized clinical trial. Leuk Res 37:259–265. https://doi.org/10.1016/j.leukres.2012.11.017
doi: 10.1016/j.leukres.2012.11.017
pubmed: 23273538
Fenaux P, Giagounidis A, Selleslag D et al (2011) A randomized phase 3 study of lenalidomide versus placebo in RBC transfusion-dependent patients with Low-/Intermediate-1-risk myelodysplastic syndromes with del5q. Blood 118:3765–3776. https://doi.org/10.1182/blood-2011-01-330126
doi: 10.1182/blood-2011-01-330126
pubmed: 21753188
Ivy KS, Brent Ferrell Jr P (2018) Disordered immune regulation and its therapeutic targeting in myelodysplastic syndromes. Curr Hematol Malig Rep 13:244–255. https://doi.org/10.1007/s11899-018-0463-9
doi: 10.1007/s11899-018-0463-9
pubmed: 29934935
pmcid: 6560359
Schwartz RM, Ornstein KA, Liu B, Alpert N, Bevilacqua KG, Taioli E (2019) Change in quality of life after a cancer diagnosis among a nationally representative cohort of older adults in the US. Cancer Invest 37:299–310. https://doi.org/10.1080/07357907.2019.1645160
doi: 10.1080/07357907.2019.1645160
pubmed: 31379217
pmcid: 6755900
Reeve BB, Potosky AL, Smith AW et al (2009) Impact of cancer on health-related quality of life of older Americans. J Natl Cancer Inst 101(12):860–868. https://doi.org/10.1093/jnci/djp123
doi: 10.1093/jnci/djp123
pubmed: 19509357
pmcid: 2720781
Haapanen N, Miilunpalo S, Pasanen M, Oja P, Vuori I (1997) Agreement between questionnaire data and medical records of chronic diseases in middle-aged and elderly Finnish men and women. Am J Epidemiol 145:762–769. https://doi.org/10.1093/aje/145.8.762
doi: 10.1093/aje/145.8.762
pubmed: 9126003
Bergmann MM, Calle EE, Mervis CA, Miracle-McMahill HL, Thun MJ, Heath CW (1998) Validity of self-reported cancers in a prospective cohort study in comparison with data from state cancer registries. Am J Epidemiol 147(6):556–562. https://doi.org/10.1093/oxfordjournals.aje.a009487
doi: 10.1093/oxfordjournals.aje.a009487
pubmed: 9521182
Okura Y, Urban LH, Mahoney DW, Jacobsen SJ, Rodeheffer RJ (2004) Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure. J Clin Epidemiol 57(10):1096–1103. https://doi.org/10.1016/j.jclinepi.2004.04.005
doi: 10.1016/j.jclinepi.2004.04.005
pubmed: 15528061
Hernán MA, Robins JM (2020) CausalInference: What If. Chapman&Hall/CRC, BocaRaton