Hemoglobin is a key determinant of quality of life before and during azacitidine-based therapy for myelodysplasia and low blast count acute myeloid leukemia

Abstract

Myelodysplastic syndromes (MDS) have a major impact on quality of life (QoL). We performed a post hoc analysis of two multicenter trials of azacitidine-based disease-modifying therapy for patients with MDS and low blast count acute myeloid leukemia (AML), to identify factors associated with QoL. 231 patients were included (median age 70 years). At baseline, higher initial hemoglobin, but not neutrophil or platelet count, was associated with better global QoL and physical function (p < 0.001 and p = 0.001, respectively). During therapy, increase in hemoglobin was associated with improvement in QoL and physical function (p = 0.005 and p < 0.001, respectively). Lower initial hemoglobin was associated with higher dyspnea and fatigue scores (p < 0.001 and p = 0.001, respectively), and hemoglobin response was associated with improvement in dyspnea and fatigue (p < 0.001 for each). In patients with MDS and low blast count AML, hemoglobin level was strongly correlated with global QoL, physical functioning, dyspnea and fatigue, both before and during azacitidine-based therapy.

Keywords:

• Myelodysplastic syndrome
• acute myeloid leukemia
• azacitidine
• quality of life
• hemoglobin
• red cell transfusion

Acknowledgements

The authors thank the study investigators of the ALLG MDS3 and ALLG MDS4 trials, participating sites and their research staff. The authors thank Robert Gotmaker for assistance with figures.

Disclosure statement

ZM and RW contributed to the concept of the study. All authors contributed to the study design. MK and JFS were principal investigators on the clinical trials from which the datasets were obtained. ZM and LB performed the analysis. ZM drafted the manuscript. All authors revised and approved the final version of the manuscript.

ZKM, EW, MK and JFS received research funding from Celgene. MK and JFS are advisory board members for Celgene. JFS is a member of speakers bureau for Celgene.

Additional information

Funding

ZM is supported by an Australian National Health and Medical Research Council (NHMRC) Early Career Fellowship [APP1111485]. RW is supported by a Health Research Council of New Zealand Clinical Practitioner Research Fellowship (19/139). The ALLG received funding support and investigational agent supply from Celgene Pty Ltd for the ALLG MDS3 and ALLG MDS4 trials.