Abstract 1739

BACKGROUND:

Differences in symptom burden characteristics between persons of European and non-European descent with BCR-ABL negative MPNs including essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (MF) are not studied. We reported significant clinical and laboratory differences between these populations age at diagnosis and survivals (Blood 2011;119: 2469–73) which could affect symptom burden. Given China represents one-fifth of the global population, we aimed to evaluate MPN symptom burden among a cohort of Chinese MPN patients.

METHODS:

Data were collected from Chinese with MPNs and their physicians and compared these to a previously collected data from a cohort of subjects of predominately European descent (N=1488). Subject data included MPN-SAF (Blood 2011;118:401-8) and BFI score (Cancer 1999;85: 1186–96), demographics, and disease-related features. Statistical methods included ANOVA, chi-squared tests, and multiple regressions.

RESULTS:
Demographic and Disease Characteristics:

397 Chinese subjects were prospectively enrolled with a distribution of 172 (43%) ET, 102 (26%) PV, and 123 (31%) MF (of which 103 [84%] were PMF, 14 [11%] were post-ET MF, and 6 [5%] were post-PV MF). Median age (56.0 y) was younger in Chinese than in the European-descent cohort (63.0 y, p<0.001) despite relative gender equality. Laboratory abnormalities including anemia (76%, p<0.001) and disease features including bleeding (1%, p<0.001), were more common and present at a significantly higher incidences in the European-descent cohort than amongst Chinese.

Chinese Symptom Severity and Incidence by MPN type:

When comparing across MPN types, symptoms of worst fatigue, early satiety, abdominal discomfort, inactivity, concentration, depression, cough, night sweats, weight loss, and total MPN-SAF TSS score varied significantly (p<0.05) with MF being most severe for each symptom.

Chinese versus European-descent Symptom Severity:

After adjusting for age and MPN type, Chinese subjects had significantly higher mean severity for fever, sexual difficulties, and quality of life (Table 1). Symptoms of worst fatigue, early satiety, abdominal discomfort and overall BFI score had a significantly higher mean severity in the European descent cohort.

Chinese versus European-descent Symptom Incidence:

The European-descent cohort had significantly greater incidence of worst fatigue (90% vs 81%, p<0.001), abdominal pain (47% vs 35%, p<0.001), early satiety (65% vs 57%, p=0.005), concentration problems (64% vs 58%, p=0.04), numbness (63% vs 56%, p=0.02), insomnia (68% vs 58%, p<0.001), and depression (62% vs 56%, p=0.02) compared to Chinese subjects. In contrast, symptoms of dizziness (63% vs 57%, p=0.04), sexual difficulties (72% vs 61%, p<0.001), and fever (23% vs. 18%, p=0.03) were significantly worse amongst Chinese.

CONCLUSION:

We found a significant divergence in severity and incidence of key symptom burdens including QOL, fever, sexuality, dizziness, abdominal pain, early satiety, and fatigue between Chinese and persons of European descent with MPNs. Biological and cultural factors likely account for these differences and should be considered when interpreting outcomes of clinical trials of diverse populations. When the target of therapy is reversing symptoms, the best strategy may require revision for different populations.

Table 1.

Symptom burden in Chinese and Western cohorts.

Chinese (n=397)Western (n=1488)
Symptom/MeasureMean (SD)Mean (SD)
BFI (mean) 2.8 (2.4)* 3.5 (2.3)* 
Worst Fatigue (BFI) 3.9 (3.0)* 5.1 (2.8)* 
Early Satiety 2.3 (2.8)* 2.5 (2.8)* 
Abdominal Pain 1.1 (2.1)* 1.5 (2.3)* 
Abdominal Discomfort 1.9 (2.6) 2.1 (2.5) 
Inactivity 2.6 (2.9) 2.3 (2.7) 
Headache 2.1 (2.7) 1.7 (2.4) 
Concentration Difficulties 2.4 (2.9) 2.8 (2.8) 
Dizziness 2.8 (3.0)* 2.0 (2.6)* 
Numbness 2.4 (2.9) 2.5 (2.8) 
Insomnia 2.8 (3.2) 3.5 (3.1) 
Sad Mood 2.6 (3.1) 2.2 (2.7) 
Sexuality 4.7 (4.0)* 3.3 (3.5)* 
Cough 1.4 (2.3) 1.5 (2.3) 
Night Sweats 2.3 (3.1) 2.2 (2.9) 
Itching 2.1 (2.8) 2.2 (3.0) 
Bone Pain 2.0 (2.7) 1.9 (2.8) 
Fever 0.7 (1.7)* 0.4 (1.1)* 
Weight Loss 1.8 (2.7) 1.1 (2.2) 
Overall QOL 3.0 (2.6)* 2.8 (2.5)* 
MPN-TSS 22 (18.0) 21 (16.3) 
Chinese (n=397)Western (n=1488)
Symptom/MeasureMean (SD)Mean (SD)
BFI (mean) 2.8 (2.4)* 3.5 (2.3)* 
Worst Fatigue (BFI) 3.9 (3.0)* 5.1 (2.8)* 
Early Satiety 2.3 (2.8)* 2.5 (2.8)* 
Abdominal Pain 1.1 (2.1)* 1.5 (2.3)* 
Abdominal Discomfort 1.9 (2.6) 2.1 (2.5) 
Inactivity 2.6 (2.9) 2.3 (2.7) 
Headache 2.1 (2.7) 1.7 (2.4) 
Concentration Difficulties 2.4 (2.9) 2.8 (2.8) 
Dizziness 2.8 (3.0)* 2.0 (2.6)* 
Numbness 2.4 (2.9) 2.5 (2.8) 
Insomnia 2.8 (3.2) 3.5 (3.1) 
Sad Mood 2.6 (3.1) 2.2 (2.7) 
Sexuality 4.7 (4.0)* 3.3 (3.5)* 
Cough 1.4 (2.3) 1.5 (2.3) 
Night Sweats 2.3 (3.1) 2.2 (2.9) 
Itching 2.1 (2.8) 2.2 (3.0) 
Bone Pain 2.0 (2.7) 1.9 (2.8) 
Fever 0.7 (1.7)* 0.4 (1.1)* 
Weight Loss 1.8 (2.7) 1.1 (2.2) 
Overall QOL 3.0 (2.6)* 2.8 (2.5)* 
MPN-TSS 22 (18.0) 21 (16.3) 

All symptoms were rated on a 0 (absent) to 10 (worst-imaginable) scale.

MPN-TSS is calculated on 0 (no symptoms) to 100 (all symptoms worst imaginable) scale.

*

P-value between cohorts was significant (p<0.05) after adjusting for MPN type and age.

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Disclosures:

Mesa:Incyte: Research Funding; Lilly: Research Funding; Sanofi: Research Funding; NS Pharma: Research Funding; YM Bioscience: Research Funding.

Topics:
abdominal pain, anemia, bcr-abl tyrosine kinase, bone pain, cancer, china, cough, depressive disorders, dizziness, early satiety

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2012 by The American Society of Hematology
2012
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