Improved relapse-free survival after autologous stem cell transplantation does not translate into better quality of life in chronic lymphocytic leukemia: lessons from the randomized European Society for Blood and Marrow Transplantation-Intergroup study

de Wreede, Liesbeth C; Watson, Maggie; van Os, Marleen; Milligan, Donald; van Gelder, Michel; Michallet, Mauricette; Dreger, Peter; Dearden, Claire E; Homewood, Janis; Dupuis, Jehan; Leporrier, Michel; Karas, Michal; Corront, Bernadette; Baerlocher, Gabriela M.; Herr, Wolfgang; Choquet, Sylvain; Niederwieser, Dietger W; Sutton, Laurent; Kröger, Nicolaus; de Witte, Theo M; ... (2014). Improved relapse-free survival after autologous stem cell transplantation does not translate into better quality of life in chronic lymphocytic leukemia: lessons from the randomized European Society for Blood and Marrow Transplantation-Intergroup study. American journal of hematology, 89(2), pp. 174-180. Wiley-Liss 10.1002/ajh.23610

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In chronic lymphocytic leukemia (CLL) medical progress is driven by clinical studies with relapse-free survival (RFS) as the primary endpoint. The randomized EBMT-Intergroup trial compared high-dose therapy and autologous stem cell transplantation (ASCT) to observation and demonstrated a substantial improvement of RFS without showing improved overall survival for the transplant arm. Here we report quality of life (QoL) information of the first 3 years following randomization from that study. The main objective was to assess the impact of treatment on QoL over time. Two secondary analyses were performed to further investigate the impact of ASCT and relapse on QoL. In the primary analysis, we demonstrate an adverse impact of ASCT on QoL which was largest at 4 months and continued throughout the first year after randomization. Further, we demonstrated a sustained adverse impact of relapse on QoL which worsened over time. Despite better disease control by ASCT the side effects thus turned the net effect towards inferior QoL in the first year and comparable QoL in the following 2 years after randomization. This study emphasizes the importance of information concerning QoL impacts when patients are counseled about treatments aimed at improving RFS in the absence of a survival benefit.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory

UniBE Contributor:

Baerlocher, Gabriela M.

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0361-8609

Publisher:

Wiley-Liss

Language:

English

Submitter:

Verena Zwahlen

Date Deposited:

26 Mar 2015 11:45

Last Modified:

16 Sep 2017 04:53

Publisher DOI:

10.1002/ajh.23610

PubMed ID:

24123244

Additional Information:

On behalf of the Chronic Malignancies Working Party of the EBMT, and the UK Medical Research Council

BORIS DOI:

10.7892/boris.66095

URI:

https://boris.unibe.ch/id/eprint/66095

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