Quality of life in chronic lymphocytic leukemia: 5-year results from the multicenter randomized LRF CLL4 trial

Abstract

Health-related quality of life (HRQoL) is a key issue for patients with chronic lymphocytic leukemia. The multicenter LRF CLL4 trial, in which 777 patients were randomized to receive chlorambucil or fludarabine, alone or with cyclophosphamide (FC), assessed HRQoL at baseline, months 3, 6 and 12, then annually until 5 years, using the European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC-QLQ-C30). While on treatment, some HRQoL impairment was seen in patients receiving fludarabine, particularly FC, compared with chlorambucil. Thus at 3 months, role/social functioning and fatigue were ≥ 10 points worse than baseline in 41%/46%/56%, respectively, of patients receiving fludarabine alone and 48%/54%/60% receiving FC, compared with only 29%/31%/40% of those receiving chlorambucil. Thereafter HRQoL appeared similar between treatment groups. Sustained remissions were associated with long-term HRQoL benefit. In the primary HRQoL domains patients still in complete or partial remission at each time-point had scores close to those reported in general population studies, while patients whose disease had progressed had mean scores up to 22 points worse, in spite of subsequent treatments. These data offer support for the use of primary treatment regimens likely to achieve and sustain remission in otherwise medically fit patients of all ages, including those aged > 70 years.

Keywords::

• Health-related quality of life
• chronic lymphocytic leukemia
• chlorambucil
• fludarabine
• fludarabine and cyclophosphamide

Acknowledgements

The LRF CLL4 trial was funded by a core grant from Leukaemia & Lymphoma Research. The Clinical Trial Service Unit received research support from the Medical Research Council and Cancer Research UK. M.E. was supported by the Arbib Foundation.

The authors would like to thank Margaret Course for collecting and entering the EORTC-QLQ-C30 data. We would also like to thank all the patients for their cooperation in completing and returning the questionnaires and the various site investigators for their participation in this trial.

Potential conflict of interest

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