Research suggests that although patients with lower-risk myelodysplastic syndromes (MDS) tend to experience better health-related quality of life (HRQoL), for “vulnerable” patients, such as those who have difficulty with prolonged physical activity, there is no association between HRQoL and MDS disease risk. The researchers, led by Gregory Abel, MD, MPH, of Dana-Farber Cancer Institute in Boston, demonstrated for the first time that vulnerability outweighs disease risk in regard to HRQoL and that cytopenias leading to MDS evaluation are associated with similar HRQoL, regardless of eventual diagnosis. The research was published in Blood Advances.
The study included 480 patients (93% white) from the National Heart, Lung, and Blood Institute-sponsored MDS Natural History Study. The investigators evaluated HRQoL and vulnerability data from patients undergoing diagnostic work-up for suspected MDS or MDS/myeloproliferative neoplasms (MPNs) who were then enrolled for longitudinal follow-up. When the researchers compared patients across diagnostic categories, their age differed significantly (p=0.04), with the MDS/MPN group being the oldest on average (mean = 77 ±7 years) and the idiopathic cytopenia of undetermined significance (ICUS) group being the youngest (mean = 70 ±12 years).
The researchers found no significant difference in HRQoL among all cytopenia diagnostic categories. “We were surprised to find that baseline HRQoL was not worse among patients who truly had MDS versus those who had other reasons for cytopenias,” said Dr. Abel. “This finding is likely due to HRQoL being driven by symptoms related to abnormal blood counts, which occurred in all patients being evaluated for possible MDS.”
The paper includes some of the first data on HRQoL and vulnerability for patients with ICUS. MDS and related hematologic conditions tend to affect individuals of advanced age and thus, Dr. Abel explained, vulnerability was prevalent in this population, with more than one-third of the MDS cohort scoring vulnerable on the Vulnerable Elders Survey. HRQoL was similar between those with ICUS and those with MDS/MPN, and vulnerability was a bit less common for the ICUS group (25% vs. 36% for patients with MDS). The investigators were unable to use HRQoL to predict whether patients with cytopenias had MDS in their bone marrow. “Our analyses affirm the need for a baseline marrow assessment to diagnosis MDS—even among patients with suspected disease who feel well—and suggest that both HRQoL and several specific questions about physical function be a routine part of MDS care,” said Dr. Abel.
In the overall cohort, vulnerable participants had significantly worse HRQoL on all measures except PROMIS fatigue for MDS/MPN, ICUS, acute myeloid leukemia with blasts below 30%, and “at-risk,” both when pooled over all diagnostic categories and within each diagnostic category. The investigators found that patients with confirmed MDS experienced a significant trend of worsening HRQoL with worse MDS or MDS/MPN disease prognosis for all overall HRQoL scores, with decreasing EuroQoL-5D-5L mean scores of 73.4, 72.7, and 64.1 for low-, intermediate-, and high-risk MDS or MDS/MPN, respectively (p=0.005). Functional Assessment of Cancer Therapy – General and PROMIS fatigue scores were not significantly different across groups.
Patients with International Prognostic Scoring System-revised (IPSS-R) higher-risk MDS had modestly impaired HRQoL. HRQoL impairment among patients with MDS was similar to that routinely seen for some solid malignancies. Finally, many of the vulnerable participants with MDS (n=84) had difficulty with prolonged physical activity (88%), such as walking a quarter mile (74%). “As MDS is generally a disease of older adults, our data provide important insight into how aging, vulnerability, and HRQoL interact in this population,” said Dr. Abel.
Any conflicts of interest declared by the authors can be found in the original article.
Reference
Abel GA, Hebert D, Lee C, et al. Health-related quality of life and vulnerability among people with myelodysplastic syndromes: a US national study [published online ahead of print, 2023 May 5]. Blood Adv. doi: 10.1182/bloodadvances.2022009000.
