Patient–reported fatigue prior to treatment is prognostic of survival in patients with acute myeloid leukemia
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Tamara E. Lacourt1, Annemieke Kavelaars1, Maro Ohanian2, Nina D. Shah3, Samuel A. Shelburne4,5, Andrew Futreal5, Dimitrios P. Kontoyiannis4 and Cobi J. Heijnen1
1Neuroimmunology Laboratory, Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
2Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
3Department of Medicine, University of California San Francisco, San Francisco, California, USA
4Department of Infectious Disease, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
5Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
Tamara E. Lacourt, email: TLacourt@MDAnderson.org
Keywords: fatigue; mortality; Kaplan-Meier; Cox regression; patient-reported outcome
Received: April 16, 2018 Accepted: July 08, 2018 Published: July 27, 2018
Acute myeloid leukemia (AML) is associated with poor survival. While clinical prognostic factors of survival have been identified, the contribution of patient-reported symptoms has only received marginal attention. Fatigue is one of the most commonly reported symptoms of AML. There is some evidence that fatigue is associated with shorter survival in hematological malignancies. However, the prognostic effects of fatigue in a homogenous cohort of patients with untreated AML has not been tested. We here report results of a prospective study on the prognostic value of patient-reported fatigue prior to onset of treatment, for 2-year survival in 94 AML patients. Cox regression models controlling for demographic and clinical factors showed that those with severe fatigue (22%) had decreased survival rates (Hr = 2.255, 95% CI = 1.16-5.60, p = 0.019). Further exploration showed that fatigue was associated with increased plasma concentrations of IL-6 and TNF-α, but not with demographic or disease-related factors. In conclusion, we here show for the first time that the experience of severe fatigue prior to remission induction chemotherapy (IC) is prognostic for shorter survival in patients with AML of all ages. These findings point to the importance of interventions aimed at relieving fatigue especially before or in the early phases of treatment in order to improve survival.
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