Comparison of the 5 Year Medical Outcome and Quality of Life of Patients with Chronic Myeloid Leukemia Treated with Imatinib or Allogeneic Transplant

Comparison of the 5 year Medical Outcome and Quality of Life of Patients with Chronic Myeloid Leukemia treated with Imatinib or Allogeneic Transplant Jianyu Weng1*, Lisi Huang1*, Peilong Lai1, Zesheng Lu1, Ping Wu1, Suijing Wu1, Chengwei Luo1, Wei Ling1, Chenxin Deng1, Xin Huang1, Suxia Geng1, Xin Du1? 1Department of Hematology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, P.R. China. *These authors contributed equally to this work.? Corresponding author: Xin Du, MD, Ph.D. 106. Zhongshan Er Rd, Guangzhou, 510080, P.R. China E-mail: miyadu@hotmail.com Phone: (86)-20-83827812-62122 Fax: (86)-20-83889772 Abstract To evaluate and compare the long-term medical outcome and health-related quality of life (HRQOL) of patients with CML in chronic phase (CML-CP) who received imatinib or an allogeneic hematopoietic stem cell transplant (allo-HSCT) using retrospective analysis and an embedded cross-sectional study. CML-CP patients who received imatinib or transplantation from January 4, 2004 to October 10, 2011 in the Department of Hematology at Guangdong General Hospital (GGH) were enrolled in this study. A total of 131 patients, including 90 and 41 in the imatinib and allo-HSCT groups, respectively, were enrolled. The two groups including HRQOL investigation were well matched for gender, marital status, employment status, educational background, and Sokal score at diagnosis. There were no significant differences in the five-year EFS, PFS and OS between the two groups. The HRQOL was measured using EORTC QLQ-C30. Those questions include five multi-item function scales (Physical, Role, Emotional, Cognitive and Social Functioning), a combined Global Health Status/QOL scale, and a number of individual items (appetite loss, dyspnea, diarrhea, constipation, sleep disturbances, and financial impact). In terms of HRQOL, with the exception of social functioning (64.9 vs. 77.5, P=0.035), there was no significant difference in many of the HRQOL scores between the imatinib and transplant groups: global HRQOL, role function, physical function, emotional function and cognitive function. However, symptoms including nausea/vomiting (14.8 vs. 3.2, P=0.013), diarrhea (18.4 vs. 2.5, P=0.001), and financial difficulty (56.9 vs. 33.3, P=0.023) more negatively impacted the imatinib group (P<0.05). Persistent cGVHD reduced the HRQOL of the allo-HSCT group, compared with the non-cGVHD and historic cGVHD group. Although imatinib and transplantation have similar long-term medical outcomes, allo-HSCT provides better social function, moderate symptoms, and lower financial burden. Thus, the role of allo-HSCT for CML-CP should be reevaluated in developing countries in the era of TKIs. Keywords: chronic myeloid leukemia; quality of Life CONFLICT OF INTEREST The authors declare no conflict of interest. ACKNOWLEDGMENTS This work was supported by the National Natural Science Foundation of China (Grant No. 81270648, 81300446 and 81370665), Science and Technology Planning Project of Guangzhou (Grant No.201400000003-4, 201400000003-1).