Dinamic Evaluation of Quality of Life and Late Effects in a Cohort of Acute Myeloid Leukemia Long Term Survivors

Late effects and quality of life (QoL) in Acute Myeloid Leukemia (AML) long term adult survivors represent an unexplored field of interest. We prospectively evaluated late effects and dynamic QoL in 44 and 29 cured AML patients (17 <60 years, and 12 >60 years), treated at our department between 1997 and 2010 (7 Allogeneic, 16 Autologous Transplant, 21 chemotherapy alone). We administered EORTC QLQ-C30 and FACT-AN questionnaires at two different time points with a median interval of 29 months (range: 12-34 months). We stratifyed QoL scores by age at diagnosis, performance status (PS), Sorror Index, kind of leukemia treatment, comorbidity at diagnosis.

We observed a worsening of emotional (-9.03; p= 0.04) and cognitive (-6.94; p= 0.05) EORTC scale scores, while FACTG (+2.9; p=0.03), emotional (+1.1; p= 0.04) and Functional (+2.25; p=0.001) well being FACT scores increased.

Multivariate analysis showed that older patients had worse EORTC QLQ-C30 physical and emotional scale scores and higher values of pain symptoms in comparison to younger counterpart, with RR of 20.1 (p = 0.001), 22.7 ( p <0.04) and 18.4 (p=0.03) respectively. Elderly patients also had lower Total Outcome Index and FACT-An subscale scores (RR: 11.9, p= 0.02; and 8.77, p= 0.04 respectively). Sorror index > 2 was related to lower EORTC QLQ-C30 social scale and dyspnea scores (RR: 32.5; p=0.001 and 21.7; p=0.001 respectively) and FACT-An functional well being values (RR=3.9; p=0.001).

We evaluated late effects occurring in 44 patients, since the third month after the end of treatment, with a median follow-up of 70 months (range: 12-166 months). The most frequent grade II-IV late toxicity was cardiac (3 arythmia, 9 cardiomyopathy) with 89% incidence in patients with Sorror HCT-CI score>2 at diagnosis vs 8.8% in the remaining patients and 0%, 20% and 55.5% in patients receiving respectively Daunorubicin, Idarubicin and at least two different anthracyclines. Sorror Index>2 was the only factor significantly predicting cardiotoxicity at the multivariate analysis with a RR of 82.7 (p=0.001). Twelve patients developped a transient hemochromatosis secondary to transfusions, treated with phlebotomy in 3 cases. Three patients (2 males and 1 female) had been fertile; all female patients developped menopause after Transplant. Four patients had secondary neoplasia consisting of Multiple Myeloma, breast cancer, myelodisplasia and axillary sarcoma.

Our study underlines the role of Sorror Index at diagnosis in defining patients eligibility to cardio-prophylactic therapy. The analysis of larger series of cured AML patients are strongly needed in order to define guidelines for reducing long term treatment AML toxicity.