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2904 Fatigue and Daily Life in Patients with Essential Thrombocythemia: Comparisons Between the USA and France in 447 Patients

Oral and Poster Abstracts
Poster Session: Myeloproliferative Syndromes Poster II
Sunday, December 6, 2009, 6:00 PM-8:00 PM
Hall E (Ernest N. Morial Convention Center)
Poster Board II-880

Ruben A. Mesa, MD1, Jerome Rey, MD2*, Ayalew Tefferi, MD3, Joyce Niblack, JD4*, Pascal Lenain5*, Emmanuel Raffoux, MD6*, Thierry De Revel, MD, PhD7, John Camoriano, MD1 and Jean-Jacques Kiladjian, MD, PhD8*

1Mayo Clinic, Scottsdale, AZ
2Institute Paoli-Calmettes, Marseille, France
3Hematology, Mayo Clinic, Rochester, MN
4CMPD Education Foundation
5Service d'Hématologie, Centre Henri Becquerel, Rouen, France
6Dept. of Hematology, EA 3518, Université Paris VII, Hopital Saint Louis, AP-HP, Paris, France
7Dept. of Hematology, Hopital Percy, Clamart, France
8Clinical Investigation Center (CIC), Hopital Saint-Louis & French Intergroup of Myeloproliferative disorders (FIM), Paris, France

Background: The myeloproliferative neoplasm (MPN) of essential thrombocythemia (ET) can cause a constellation of symptoms in afflicted patients either from direct consequence of vascular and circulatory events (i.e. thrombosis, hemorrhage, erythromelalgia), or more indirectly as a consequence of the myeloproliferation itself (fatigue, pruritus, constitutional symptoms). These latter symptoms, of significant importance to patients, are more challenging for physicians to interpret given they are self reported by patients and influenced by many factors including culture. We sought to identify the concordance of self reported fatigue, and impact on daily life in patients with ET between 2 large and independently administered studies performed in the USA and France, respectively. Methods: Two large, separate, trials of symptomatic burden were used for the analysis. The first an internet based trial originating from the USA of self reported symptoms across the spectrum of patients with MPNs (Mesa et. al. Cancer 2007), the data included in this analysis a previously unreported subset analysis on patients from the USA with ET. The second trial a multi-centre, prospective questionnaire based analysis including many aspects of the impact of ET upon patients in France including fatigue and daily life. Key areas of overlap between these 2 trials were analyzed to assess whether any substantive differences in the impact of ET on daily life or fatigue between these 2 patient groups.

Results:
PATIENTS: A total of 447 patients with ET were included in the analysis (222 from the French Series (median age 57.8 years (range 19-90), 225 from the USA Series (median age 53 years (range 16-82)). In the 2 series, respectively, 78%, and 77% received cytoreductive therapy, and 16%, and 22% had a history of a vascular event.

FATIGUE AND IMPACT ON DAILY LIFE: Fatigue was a self reported problem across the majority respondents in this analysis 287/447 (64%) self reporting fatigue as a problem. The prevalence of fatigue did not vary significantly between the 2 countries (158/225 (70.2%) - USA, - 129/222 (58%) – France). In contrast, in the French study where parallel questionnaires were completed by the patients and their hematologists, the doctor considered fatigue as a significant symptom in only 17% of patients. Additionally the majority of respondents felt the ET was the reason, at least partially, for their fatigue (316/447; 71%)  again with no significant difference amongst the regions (69% USA, 73% France). Self reported metrics such as decreased libido (25% USA, 24% France) demonstrated remarkable similarity across cultural and geographic differences. Finally when asked directly whether ET negatively impacted their daily life, 46% of US patients responded in the affirmative (ranging from modest to severe impact). In France), the patients reported impact of ET on their: professional life (37%), hobbies (24%) and mood (74%).

Conclusions:  The symptomatic impact of a diagnosis of ET upon afflicted patients is significant, present in a majority of patients, and surprisingly consistent across 2 different cultural and geographic regions. The deep difference between patient's and doctors' consideration of fatigue as a meaningful symptom underlines the need for objective symptom assessment tools in MPN.

(The French portion of this study was sponsored by Shire, Inc.)

Disclosures: No relevant conflicts of interest to declare.

*signifies non-member of ASH