Abstract
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.
Highlights
Acute myeloid leukemia (AML), a hematological cancer in which cancerous myeloid blasts do not develop into mature white blood cells, is associated with poor survival [1]
We here show for the first time that the experience of severe fatigue prior to remission induction chemotherapy (IC) might be prognostic for shorter overall survival in patients with AML of all ages
The association between fatigue and survival has previously been reported for patients with myeloid dysplastic syndrome (MDS) who were tested for fatigue within six months of diagnosis [11] as well as in an elderly population including both AML and MDS patients [13]
Summary
Acute myeloid leukemia (AML), a hematological cancer in which cancerous myeloid blasts do not develop into mature white blood cells, is associated with poor survival [1]. As the study included patients with a diagnosis of MDS, in whom fatigue has been shown to predict survival, it is unclear whether the results would be applicable to the AML patients. Timilshina et al [14] studied AML patients only and did not find fatigue prior to or at the start of remission induction chemotherapy (IC) to be a prognostic factor in AML patients Their time frame of 60 days led to a very low mortality rate (i.e., 3.7%), which would have obscured any potential effects. It remains unclear whether fatigue assessed prior to initiation of treatment is prognostic of long-term survival in AML patients
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