Quality of Life of Long Term Survivors with Follicular Lymphoma After High-Dose Chemotherapy with Autologous Stem Cell Transplantation and Conventional Chemotherapy.

High-dose chemotherapy (HDCT) followed by peripheral blood stem cell transplantation (PBSCT) is frequently applied in eligible patients with relapsed or refractory follicular lymphoma (FL). The toxicity of HDCT, however, might manifest itself in the respective patients' reduced quality of life (QoL). In this study we investigated the QoL of long term survivors after HDCT in comparison with patients after conventional chemotherapy and the healthy German population.

QoL was evaluated with the standardized questionnaires EORTC QLQ-C30 and EQ-5D. A total of 124 patients with FL were included in the study. 63 patients (29 female) with a median age of 60.4 (range 41–80) received HDCT with PBSCT between 1992 and 2002. This group was compared with 61 patients (38 female) with a median age of 62.9, range 31–81) who were treated with Rituxmab and CHOP chemotherapy and supplementary radiation in our institution. 55 patients of 63 (88%) of the HDCT group and 25 of 61 (41%) patients of the conventional group were in continuous complete remission (CR). Median follow-up for the HDCT group is 9 years and for the conventional chemotherapy group it is 4.4 years. In addition, QoL of the patients was compared to QoL of healthy people on the basis of two studies about the general health status of the German population (R. Schwarz and A. Hinz: “Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population,” European Journal of Cancer 37 [2001]: 1345–1351; H. H. König et al.: “Health Status of the German Population: Results of a Representative Survey Using the EuroQoL Questionnaire,” Gesundheitswesen 67 [2005]: 173–182).

In the HDCT group, the results of the questionnaires show a reduced QoL compared to the healthy population. Regarding the three main categories of the EORTC QLQ-C30, the mean sum score for global health state (ghs) is 71.38, for functional state (fs) 78.38 and for symptomatic state (ss) 18.60 (the ideal score being 100.00 for the first two items and 0.00 for the latter). The mean value for EQ-5D is 0.911 (ideal value: 1.000) and that for VAS is 75.52 (ideal value: 100.00). The one sample t-test evaluation shows that the decrease in QoL is significant with p<0.05 in four of five of the subcategories of the functional state; six of the nine subcategories of the symptomatic state, namely fatigue, dyspnoea, insomnia, constipation, diarrhoea and financial difficulties. Patients who received conventional chemotherapy (ghs: 67.04; fs: 70.49; ss: 25.01) also showed a reduced QoL compared to the healthy population in all of the three main categories of the EORTC-QLQ-C30, in particular in the category of functional and symptomatic state. These differences were statistically significant in all subcategories of the functional state namely physical,-role,-emotional,-cognitive,- and social functioning (p=0.001). The differences of the symptomatic state were statistically significant in seven of nine subcategories, namely fatigue, pain, dyspnoea, insomnia, constipation, diarrhea and financial difficulties. When QoL of the HDCT group and the conventional therapy group were compared, there were significant differences in favor of the HDCT group only in the functional subcategory social functioning (p=0.04) and the symptomatic subcategory pain (p=0.01), with no significant differences in all other categories. In the EQ-5D questionnaire, we found a reduced QoL in patients after conventional chemotherapy compared to HDCT patients (p=0.05) and healthy people (p=0.02).

In this long term follow up study, we found a reduced QoL in FL patients after conventional chemotherapy as well as after HDCT compared to the healthy population. There was a tendency of a better QoL in patients of the HDCT group compared to patients of the conventional chemotherapy group, maybe due to a higher proportion of patients in CR or a longer follow up period in the HDCT group. We conclude that the negative impact of both HDCT and conventional therapy on QoL of patients with follicular lymphoma should not be underestimated and should lead to the development of less toxic therapy strategies.

No relevant conflicts of interest to declare.