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GERMAN AMLCG-SURVIVORSHIP STUDY: QUALITY OF LIFE AND LIFE SATISFACTION IN AML LONG-TERM SURVIVORS
Author(s): ,
Eva Telzerow
Affiliations:
Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU),University Hospital, LMU Munich,Munich,Allemagne;Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU),University Hospital, LMU Munich,Munich,Deutschland;Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU),University Hospital, LMU Munich,Munich,Germania;Department of Medicine I
,
Dennis Görlich
Affiliations:
Institute of Biostatistics and Clinical Research,University of Münster,Münster,Allemagne;Institute of Biostatistics and Clinical Research,University of Münster,Münster,Deutschland;Institute of Biostatistics and Clinical Research,University of Münster,Münster,Germania;Institute of Biostatistics and Clinical Research,University of Münster,Münster,Germany;Institute of Biostatistics and Clinical Resea
,
Cristina Sauerland
Affiliations:
Institute of Biostatistics and Clinical Research,University of Münster,Münster,Allemagne;Institute of Biostatistics and Clinical Research,University of Münster,Münster,Deutschland;Institute of Biostatistics and Clinical Research,University of Münster,Münster,Germania;Institute of Biostatistics and Clinical Research,University of Münster,Münster,Germany;Institute of Biostatistics and Clinical Resea
,
Anna S. Moret
Affiliations:
Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU),University Hospital, LMU Munich,Munich,Allemagne;Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU),University Hospital, LMU Munich,Munich,Deutschland;Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU),University Hospital, LMU Munich,Munich,Germania;Department of Medicine I
,
Maja Rothenberg-Thurley
Affiliations:
Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU),University Hospital, LMU Munich,Munich,Allemagne;Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU),University Hospital, LMU Munich,Munich,Deutschland;Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU),University Hospital, LMU Munich,Munich,Germania;Department of Medicine I
,
Friederike H. A. Mumm
Affiliations:
Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU),University Hospital, LMU Munich,Munich,Allemagne;Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU),University Hospital, LMU Munich,Munich,Deutschland;Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU),University Hospital, LMU Munich,Munich,Germania;Department of Medicine I
,
Susanne Amler
Affiliations:
Institute of Biostatistics and Clinical Research,University of Münster,Münster,Allemagne;Institute of Biostatistics and Clinical Research,University of Münster,Münster,Deutschland;Institute of Biostatistics and Clinical Research,University of Münster,Münster,Germania;Institute of Biostatistics and Clinical Research,University of Münster,Münster,Germany;Institute of Biostatistics and Clinical Resea
,
Wolfgang E. Berdel
Affiliations:
Department of Medicine A, Hematology and Oncology,University of Münster,Münster,Allemagne;Department of Medicine A, Hematology and Oncology,University of Münster,Münster,Deutschland;Department of Medicine A, Hematology and Oncology,University of Münster,Münster,Germania;Department of Medicine A, Hematology and Oncology,University of Münster,Münster,Germany;Department of Medicine A, Hematology and
,
Bernhard Wörmann
Affiliations:
Charité University Hospital Berlin,Berlin,Allemagne;Charité University Hospital Berlin,Berlin,Deutschland;Charité University Hospital Berlin,Berlin,Germania;Charité University Hospital Berlin,Berlin,Germany;Charité University Hospital Berlin,Berlin,Alemania;Charité University Hospital Berlin,Berlin,Duitsland;Charité University Hospital Berlin,Berlin,Alemanha;Charité University Hospital Berlin,Berl
,
Utz Krug
Affiliations:
Department of Medicine 3,Hospital Leverkusen,Leverkusen,Allemagne;Department of Medicine 3,Hospital Leverkusen,Leverkusen,Deutschland;Department of Medicine 3,Hospital Leverkusen,Leverkusen,Germania;Department of Medicine 3,Hospital Leverkusen,Leverkusen,Germany;Department of Medicine 3,Hospital Leverkusen,Leverkusen,Alemania;Department of Medicine 3,Hospital Leverkusen,Leverkusen,Duitsland;Depart
,
Jan Braess
Affiliations:
Department of Oncology and Hematology,Hospital Barmherzige Brüder,Regensburg,Allemagne;Department of Oncology and Hematology,Hospital Barmherzige Brüder,Regensburg,Deutschland;Department of Oncology and Hematology,Hospital Barmherzige Brüder,Regensburg,Germania;Department of Oncology and Hematology,Hospital Barmherzige Brüder,Regensburg,Germany;Department of Oncology and Hematology,Hospital Barmhe
,
Pia Heussner
Affiliations:
Departement of Internal Medicine,Hospital Garmisch-Partenkirchen,Garmisch-Partenkirchen,Allemagne;Departement of Internal Medicine,Hospital Garmisch-Partenkirchen,Garmisch-Partenkirchen,Deutschland;Departement of Internal Medicine,Hospital Garmisch-Partenkirchen,Garmisch-Partenkirchen,Germania;Departement of Internal Medicine,Hospital Garmisch-Partenkirchen,Garmisch-Partenkirchen,Germany;Departeme
,
Wolfgang Hiddemann
Affiliations:
Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU),University Hospital, LMU Munich,Munich,Allemagne;Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU),University Hospital, LMU Munich,Munich,Deutschland;Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU),University Hospital, LMU Munich,Munich,Germania;Department of Medicine I
,
Karsten Spiekermann
Affiliations:
Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU),University Hospital, LMU Munich,Munich,Allemagne;Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU),University Hospital, LMU Munich,Munich,Deutschland;Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU),University Hospital, LMU Munich,Munich,Germania;Department of Medicine I
Klaus H. Metzeler
Affiliations:
Department of Medicine 1, Hematology and Cell Therapy,University Hospital Leipzig,Leipzig,Allemagne;Department of Medicine 1, Hematology and Cell Therapy,University Hospital Leipzig,Leipzig,Deutschland;Department of Medicine 1, Hematology and Cell Therapy,University Hospital Leipzig,Leipzig,Germania;Department of Medicine 1, Hematology and Cell Therapy,University Hospital Leipzig,Leipzig,Germany;D
(Abstract release date: 05/12/22) EHA Library. Telzerow E. 06/11/22; 357165; S301
Eva Telzerow
Eva Telzerow
Contributions
Abstract
Presentation during EHA2022: All Oral presentations will be presented between Friday, June 10 and Sunday, June 12 and will be accessible for on-demand viewing from Monday, June 20 until Monday, August 15, 2022 on the Congress platform.

Abstract: S301

Type: Oral Presentation

Session title: Quality of life and health econimics in hematological patients

Background

An increasing proportion of patients with acute myeloid leukemia (AML) become long-term survivors. Somatic and psycho-social outcomes in survivors are therefore becoming increasingly important, but little is known about the long-term effects of the disease and its treatment. 

Aims
The primary aim of this study was to compare quality of life (QoL, measured by the FACT-G questionnaire) and general and health-related life satisfaction (gLS/hLS, measured by the FLZ-M questionnaire) of AML-LTS with normative data of German adults who were not diagnosed with AML.

Methods
We designed a comprehensive analysis of AML survivorship outcomes including psycho-social well-being and somatic health status and conducted a questionnaire-based study collecting data from AML long term survivors (AML-LTS). This report focuses on overall and health-related quality of life. Somatic morbidity in AML-LTS is reported separately (Moret et al.). 

Results
427 former AML patients who had been enrolled in AMLCG trials (AMLCG-1999, AMLCG-2004, AMLCG-2008) or the AMLCG patient registry, participated in this study between 5 and 18.6 years (y) after their initial AML diagnosis (median, 11.3y). Median age of AML-LTS was 61y (range 28y-93y), and 56% were female. Thirty-eight percent of participants had been treated with chemotherapy alone, while 62% received at least one allogeneic stem cell transplant (alloHSCT). A relapse occurred in 24% of the participants.

Unexpectedly, age- and sex-normalized quality of life and general life satisfaction summary scores were significantly higher in AML-LTS (p<.001) compared to adults without the diagnosis of AML. Raw score points of AML-LTS on the FACT-G summary scale also were higher than in age and sex-matched normal adults by a median of 4.7 points (95% CI: 2.82 – 7.2) – a differences that likely is clinically not relevant, considering an established cutoff for clinical relevance of 7 raw score points. No difference between AML-LTS and normal adults was found for health-related life satisfaction (hLS). 

Using the cutoff for clinical importance (i.e., 7 points below age- and sex-matched population norm), 26.1% of participants reported relevant impairment of overall QoL. To identify factors potentially associated with poor overall QoL, we constructed a logistic regression model including pre-specified cofactors (age, sex, time since initial diagnosis, relapse and alloHSCT) and additional covariables that associated with QoL in univariate analyses (Figure 1). We found that participants with no children, lower educational level, shorter time since diagnosis and altered financial situation reported significantly lower QoL. No influence was found for disease- and treatment related factors including treatment (alloHSCT vs. no alloHSCT), previous relapse, or de novo vs secondary or therapy-related AML.

Conclusion
Unlike previous studies of AML survivorship, our large cohort included a diverse spectrum of patients regarding age, time since diagnosis, and treatment modalities, which allows for new insight into long-term QoL. Our study establishes that overall QoL in AML long-term survivors is comparable to the general population, with further improvement from five years post diagnosis onwards. Importantly, disease- and treatment-related factors, such as prior relapse or alloHSCT, are not associated with overall QoL. However, we were able to identify risk factors for worse QoL, delineating a subgroup of patients that may still have a need for targeted psycho-social interventions five or more years after an AML diagnosis. 

Keyword(s): AML, Long-term follow-up, Quality of life, Survival

Presentation during EHA2022: All Oral presentations will be presented between Friday, June 10 and Sunday, June 12 and will be accessible for on-demand viewing from Monday, June 20 until Monday, August 15, 2022 on the Congress platform.

Abstract: S301

Type: Oral Presentation

Session title: Quality of life and health econimics in hematological patients

Background

An increasing proportion of patients with acute myeloid leukemia (AML) become long-term survivors. Somatic and psycho-social outcomes in survivors are therefore becoming increasingly important, but little is known about the long-term effects of the disease and its treatment. 

Aims
The primary aim of this study was to compare quality of life (QoL, measured by the FACT-G questionnaire) and general and health-related life satisfaction (gLS/hLS, measured by the FLZ-M questionnaire) of AML-LTS with normative data of German adults who were not diagnosed with AML.

Methods
We designed a comprehensive analysis of AML survivorship outcomes including psycho-social well-being and somatic health status and conducted a questionnaire-based study collecting data from AML long term survivors (AML-LTS). This report focuses on overall and health-related quality of life. Somatic morbidity in AML-LTS is reported separately (Moret et al.). 

Results
427 former AML patients who had been enrolled in AMLCG trials (AMLCG-1999, AMLCG-2004, AMLCG-2008) or the AMLCG patient registry, participated in this study between 5 and 18.6 years (y) after their initial AML diagnosis (median, 11.3y). Median age of AML-LTS was 61y (range 28y-93y), and 56% were female. Thirty-eight percent of participants had been treated with chemotherapy alone, while 62% received at least one allogeneic stem cell transplant (alloHSCT). A relapse occurred in 24% of the participants.

Unexpectedly, age- and sex-normalized quality of life and general life satisfaction summary scores were significantly higher in AML-LTS (p<.001) compared to adults without the diagnosis of AML. Raw score points of AML-LTS on the FACT-G summary scale also were higher than in age and sex-matched normal adults by a median of 4.7 points (95% CI: 2.82 – 7.2) – a differences that likely is clinically not relevant, considering an established cutoff for clinical relevance of 7 raw score points. No difference between AML-LTS and normal adults was found for health-related life satisfaction (hLS). 

Using the cutoff for clinical importance (i.e., 7 points below age- and sex-matched population norm), 26.1% of participants reported relevant impairment of overall QoL. To identify factors potentially associated with poor overall QoL, we constructed a logistic regression model including pre-specified cofactors (age, sex, time since initial diagnosis, relapse and alloHSCT) and additional covariables that associated with QoL in univariate analyses (Figure 1). We found that participants with no children, lower educational level, shorter time since diagnosis and altered financial situation reported significantly lower QoL. No influence was found for disease- and treatment related factors including treatment (alloHSCT vs. no alloHSCT), previous relapse, or de novo vs secondary or therapy-related AML.

Conclusion
Unlike previous studies of AML survivorship, our large cohort included a diverse spectrum of patients regarding age, time since diagnosis, and treatment modalities, which allows for new insight into long-term QoL. Our study establishes that overall QoL in AML long-term survivors is comparable to the general population, with further improvement from five years post diagnosis onwards. Importantly, disease- and treatment-related factors, such as prior relapse or alloHSCT, are not associated with overall QoL. However, we were able to identify risk factors for worse QoL, delineating a subgroup of patients that may still have a need for targeted psycho-social interventions five or more years after an AML diagnosis. 

Keyword(s): AML, Long-term follow-up, Quality of life, Survival

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