title: Impact of different post-remission strategies on quality of life in patients with acute myeloid leukemia.
abstract: BACKGROUND
  The impact on quality of life of allogeneic stem cell transplantation or conventional chemotherapy in patients with acute myeloid leukemia remains unclear, mainly because of a lack of studies with long-term follow-up. The German AML-Intergroup, therefore, initiated a survey on quality of life of patients with a relapse-free survival of at least 5 years after first-line treatment.
  
  
  METHODS
  The EORTC Quality of Life Core Questionnaire (QLQ-C30), supplemented by information on self-assessed concomitant diseases, late treatment effects, and demographics was used. The questionnaire was returned by 419 of 818 patients (51.2%) identified by six study groups. The patients' median age at diagnosis was 42 years, and the median follow-up period was 8 years. One hundred and seventy patients were treated with stem cell transplantation (121 allogenic, 49 autologous) in first complete remission; the other 249 patients were treated with conventional chemotherapy.
  
  
  RESULTS
  The ECOG activity index revealed normal activity in 45% vs. 60% of the patients in the allogeneic stem cell transplantation vs. conventional chemotherapy groups, respectively and disabled person status in 60% vs. 35%. All QLQ-C30 functions, except physical functioning and pain, were poorer in allogeneic stem cell transplantation patients. Problems in leisure-time activities, social life, and financial management, sexual limitations and adverse effects were significantly more frequent in patients after allogeneic stem cell transplantation than after conventional chemotherapy. Multivariate logistic regression models on global health status revealed concomitant disease, age > 45 years, and allogeneic stem cell transplantation as significant risk factors.
  
  
  CONCLUSIONS
  These results indicate that, compared to conventional chemotherapy, allogeneic stem cell transplantation has a significantly worse long-term impact on quality of life. This needs to be considered when treatment options are discussed.
authors.affiliation: Institut für Med. Informationsverarbeitung, Biometrie und Epidemiologie der Universität München (IBE), Marchioninistr. 15, D-81377 München, Germany. dorle@messerer.info
authors.forename: Dorle
authors.initials: D
authors.lastname: Messerer
authors.forename: Jutta
authors.initials: J
authors.lastname: Engel
authors.forename: Joerg
authors.initials: J
authors.lastname: Hasford
authors.forename: Markus
authors.initials: M
authors.lastname: Schaich
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ehninger
authors.forename: Cristina
authors.initials: C
authors.lastname: Sauerland
authors.forename: Thomas
authors.initials: T
authors.lastname: Büchner
authors.forename: Andrea
authors.initials: A
authors.lastname: Schumacher
authors.forename: Rainer
authors.initials: R
authors.lastname: Krahl
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.forename: Jürgen
authors.initials: J
authors.lastname: Krauter
authors.forename: Arnold
authors.initials: A
authors.lastname: Ganser
authors.forename: Ursula
authors.initials: U
authors.lastname: Creutzig
authors.forename: Hartmut
authors.initials: H
authors.lastname: Döhner
authors.forename: Richard F
authors.initials: RF
authors.lastname: Schlenk
mesh_terms: D000293:Adolescent; D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000473:pathology* / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012074:Remission Induction; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome