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3698 Quality of Life Is Impaired in Anemic MDS Patients, and May Still Remain Poor Even When Hemoglobin Improves

Program: Oral and Poster Abstracts
Session: 637. Myelodysplastic Syndromes — Clinical and Epidemiological: Poster III
Hematology Disease Topics & Pathways:
Acquired Marrow Failure Syndromes, Bone Marrow Failure Syndromes, Workforce, Patient-Reported Outcomes, Diseases
Monday, December 13, 2021, 6:00 PM-8:00 PM

Yael Haring1*, Nitzan Cohen Sagy, MS1*, Shaimaa Taha, BS1*, Albert Kolomansky, MD2,3,4*, Howard S. Oster, MD, PhD3 and Moshe Mittelman, MD3,4

1Department of Internal Medicine A, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
2Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
3Department of Internal Medicine A, Tel Aviv Sourasky Medical Center/Sackler Faculty of Medicine, Tel Aviv, Israel
4Department of Hematology, Tel Aviv Sourasky Medical Center/Sackler Faculty of Medicine, Tel Aviv, Israel

Background: Quality of life (QoL) is impaired in MDS.

Aims: 1) To study QoL for various levels of anemia in MDS patients at diagnosis, 2) Compare with non-MDS controls. 3) Compare at MDS diagnosis to 1 year later.

Methods: Patients in The Israel MDS registry fill out the EQ-5D QoL questionnaire. The evaluated parameters are: mobility, self-care, daily activities, pain/discomfort and anxiety/depression, each scored 0(normal), 1(mild/moderate), or 2(poor). They also evaluate their general health using a visual analogue scale (VAS), scoring from 0 (poor) to 100(excellent). Anemia was classified as none/normal (Hb≥12.5 g/dl), mild (10≤Hb<12.5), moderate (9≤Hb<10), severe (8≤Hb<9) or very severe (Hb<8). To assess QoL dynamics, MDS patients repeat this every 6 months .

For controls, we used VAS to assess QoL of patients admitted to the Department of Medicine.

Results: In total, 126 MDS patients participated: 19, 40, 17, 21 and 29, from normal to very severe anemia, respectively. Fig.1 shows mean QoL of the 5-parameters for all patients (A), and for each individual (B), as well as the mean VAS score for all patients (C) and for each individual (D). Anemic MDS patients show a wide QoL variability (patients with the same Hb behave differently, Fig.1, B, D). Also, note the drop in QoL from moderate to severe anemia (below 9 g/dl, p=0.06, for 5-parameter; p=0.01, for VAS).

In the non-MDS controls (n=141), there was impaired QoL in anemic patients as compared to those without anemia (VAS, Figure 2; p=0.02). However, there was no significant difference in QoL among patients with various degrees of anemia.

Follow-up QoL data (1 year) were available for 61 MDS patients (Figure 3). 27 (44%) increased Hb. 32 (52%) decreased, and 2 (3%), had no change. Of the 32 who decreased Hb, average QoL deteriorated by -11.88 [95%CI: -17.96, -5.79]; 24 patients (75%, Figure 3, left-lower quadrant) had decreased VAS score; some still had improved QoL (16%), or stayed the same (9%). Of the 27 who increased Hb, average VAS still reduced by -6.48 [-14.08, 1.12]. The minority increased QoL (26%), or stayed the same (19%). Most (56%) still deteriorated in QoL (right-lower). The QoL results using the 5 parameters was consistent.

Conclusions: In this preliminary study: 1) Poor QoL in anemic MDS is variable and not linear, suggesting that other factors, in addition to Hb, affect QoL. 2) The sharp drop in QoL with Hb<9 g/dl (Figure 1, A and C from blue to pink), might lead to a therapeutic paradigm shift, with transfusion recommendations for patients with Hb<9. 3) QoL in anemic MDS patients might differ from non-MDS. 4) Anemia treatment and Hb rise are not necessarily associated with improved QoL. Larger studies will help determine QoL in MDS and other anemias and when and how to treat.

Disclosures: Mittelman: Janssen · Roche · Novartis · Takeda · Medison / Amgen · Neopharm / Celgene / BMS · Abbvie · Gilead: Research Funding; Novartis · Takeda · Fibrogen · Celgene / BMS · Onconova · Geron: Other: Clini; Onconova · Novartis · Takeda · Silence: Membership on an entity's Board of Directors or advisory committees; MDS HUB: Consultancy; Celgene / BMS · Novartis: Speakers Bureau.

*signifies non-member of ASH