A Longitudinal Comparison Of Quality Of Life (QOL) In Patients With Myeloid Malignancies Undergoing Allogeneic Hematopoietic Cell Transplantation (ALLOHCT) Using Myeloablative (MY) Or Reduced Intensity Conditioning (RIC)

There are limited data on the impact of intensity of conditioning on QOL in patients undergoing alloHCT. We undertook a prospective study to evaluate the outcomes and QOL in patients with myeloid malignancies undergoing alloHCT using MY or RIC. 115 patients were enrolled from Jan 2005 to Sep 2008 and no significant differences in the outcomes were observed in the two study cohorts at 1-year (abstract submitted separately). Of 115 patients, 105 (91%) patients (MY, 44; RIC, 61) consented to participate in QOL study with QOL assessments at baseline, day30, day100, day180 and day365. QOL was assessed by the following measures: European Organization for Research and Treatment of Cancer core 30-item questionnaire (QLQ-C30), Functional Assessment of Cancer Therapy-bone marrow transplantation subscale (FACT-BMT), FACT anaemia and fatigue subscale (FACT-An), Hospital Anxiety and Depression Scale (HADS) and Lawton and Brody's instrumental activities of daily living. Apart from age, both cohorts were well matched for baseline characteristics. The median age of patients undergoing RIC was significantly higher to those undergoing MY conditioning (59 vs. 42 yrs, p<0.0001). The compliance for completion of QOL assessments was: baseline, 98%; Day30, 91%; day100, 85%; day180, 84%; and day365, 85%. The main reason for non-compliance was illness due to toxicity or disease relapse. QOL data were analyzed for both cohorts without imputation. QOL scores did not differ for the two study groups at baseline. There was a decline in QOL scores in post transplant period with lowest scores at day30 followed by subsequent slow improvement to baseline by day365. The RIC cohort had better QLQ-C30 scores in the domains of physical functioning (p=0.005) and role functioning (p=0.02) at day30. No other significant differences were noted between the two groups at other time points. Recovery post transplant was similar in the two cohorts. In a multivariate analysis, clinically meaningful differences in favor of RIC cohort were observed in the role functioning domain of QLQ-C30. In addition, patients with HCT-comorbidity scores≥3 had significantly worse scores for emotional functioning and global health domain of QLQC-30, FACT-BMT, FACT-An and HADS. Imputing QOL data using worst scores for patients who did not complete QOL questionnaire due to illness did not significantly influence the above results. We conclude that both MY and RIC regimens resulted in similar QOL at 1-year post transplant.