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The impact of comorbidity on health-related quality of life in elderly patients with chronic myeloid leukemia


The primary objective of this study was to investigate whether the presence of comorbidities was associated with a lower health-related quality of life (HRQOL) in elderly patients with chronic myeloid leukemia (CML). A sample of 174 CML patients aged 60 years or above was analyzed. HRQOL was assessed with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). A number of pre-selected sociodemographic and disease-related factors were considered as potential confounding factors for the association between comorbidity and HRQOL. Mean age of the 174 patients analyzed was 70 years (range 60–87 years) and 55 % were male. Overall, 111 patients (64 %) reported at least one comorbidity. Analysis stratified by age group category showed a greater proportion of patients with comorbidities in the older sub-group population (≥70 years) compared to younger patients (60 to 69 years). Differences in HRQOL outcomes between patients with no comorbidity at all and those with two or more comorbid conditions were at least twice the magnitude of a clinically meaningful difference in all the physical and mental health scales of the SF-36. In multivariate analysis, after adjusting for key confounding factors, the following scales were significantly lower in those with comorbidity: general health (p < 0.001), bodily pain (p < 0.001), physical functioning (p = 0.002), and vitality (p = 0.002). Assessing comorbidity in elderly patients with CML is important to facilitate identification of those most in need of HRQOL improvements.

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  1. 1.

    Breccia M, Tiribelli M, Alimena G (2012) Tyrosine kinase inhibitors for elderly chronic myeloid leukemia patients: a systematic review of efficacy and safety data. Crit Rev Oncol Hematol 84:93–100

    PubMed  Article  Google Scholar 

  2. 2.

    Proetel U, Pletsch N, Lauseker M et al (2014) Older patients with chronic myeloid leukemia (≥65 years) profit more from higher imatinib doses than younger patients: a subanalysis of the randomized CML-Study IV. Ann Hematol 93(7):1167–76

    PubMed  PubMed Central  Article  Google Scholar 

  3. 3.

    Hoffmann VS, Baccarani M, Hasford J et al (2015) The EUTOS population-based registry: incidence and clinical characteristics of 2904 CML patients in 20 European countries. Leukemia 29:1336–43

    PubMed  CAS  Article  Google Scholar 

  4. 4.

    Rohrbacher M, Berger U, Hochhaus A et al (2009) Clinical trials underestimate the age of chronic myeloid leukemia (CML) patients. Incidence and median age of Ph/BCR-ABL-positive CML and other chronic myeloproliferative disorders in a representative area in Germany. Leukemia 23:602–4

    PubMed  CAS  Article  Google Scholar 

  5. 5.

    Harrison SJ, Johnson PR, Holyoake TL (2004) The Scotland Leukaemia Registry audit of incidence, diagnosis and clinical management of new patients with chronic myeloid leukaemia in 1999 and 2000. Scott Med J 49:87–90

    PubMed  CAS  Google Scholar 

  6. 6.

    Gugliotta G, Castagnetti F, Fogli M et al (2013) Impact of comorbidities on the treatment of chronic myeloid leukemia with tyrosine-kinase inhibitors. Expert Rev Hematol 6:563–74

    PubMed  CAS  Article  Google Scholar 

  7. 7.

    Smith AW, Reeve BB, Bellizzi KM et al (2008) Cancer, comorbidities, and health-related quality of life of older adults. Health Care Financ Rev 29:41–56

    PubMed  PubMed Central  Google Scholar 

  8. 8.

    Feinstein AR (1970) The pre-therapeutic classification of co-morbidity in chronic disease. J Cron Dis 23:455–468

    CAS  Article  Google Scholar 

  9. 9.

    Hughes T, White D (2013) Which TKI? An embarrassment of riches for chronic myeloid leukemia patients. ASH Educ Book 1:168–175

    Google Scholar 

  10. 10.

    O’Brien SG, Guilhot F, Larson RA et al (2003) Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med 348:994–1004

    PubMed  Article  Google Scholar 

  11. 11.

    Bjorkholm M, Ohm L, Eloranta S et al (2011) Success story of targeted therapy in chronic myeloid leukemia: a population-based study of patients diagnosed in Sweden from 1973 to 2008. J Clin Oncol 29:2514–20

    PubMed  PubMed Central  Article  Google Scholar 

  12. 12.

    Cortes J, Talpaz M, O’Brien S et al (2003) Effects of age on prognosis with imatinib mesylate therapy for patients with Philadelphia chromosome-positive chronic myelogenous leukemia. Cancer 98:1105–13

    PubMed  CAS  Article  Google Scholar 

  13. 13.

    Gugliotta G, Castagnetti F, Palandri F et al (2011) Frontline imatinib treatment of chronic myeloid leukemia: no impact of age on outcome, a survey by the GIMEMA CML Working Party. Blood 117:5591–9

    PubMed  CAS  Article  Google Scholar 

  14. 14.

    Pinilla-Ibarz J, Cortes J, Mauro MJ (2011) Intolerance to tyrosine kinase inhibitors in chronic myeloid leukemia: definitions and clinical implications. Cancer 117:688–97

    PubMed  CAS  Article  Google Scholar 

  15. 15.

    Hochhaus A (2011) Educational session: managing chronic myeloid leukemia as a chronic disease. Hematol Am Soc Hematol Educ Program 2011:128–35

    Article  Google Scholar 

  16. 16.

    Efficace F, Baccarani M, Breccia M et al (2011) Health-related quality of life in chronic myeloid leukemia patients receiving long-term therapy with imatinib compared with the general population. Blood 118:4554–60

    PubMed  CAS  Article  Google Scholar 

  17. 17.

    Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–83

    PubMed  Article  Google Scholar 

  18. 18.

    Efficace F, Breccia M, Baccarani M et al (2010) Development and feasibility of a patient-reported symptom checklist for chronic myeloid leukemia patients [abstract]. Haematologica 95(S2):189, Abstract 0465

    Google Scholar 

  19. 19.

    Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376

    PubMed  CAS  Article  Google Scholar 

  20. 20.

    Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–83

    PubMed  CAS  Article  Google Scholar 

  21. 21.

    Parker PA, Baile WF, de Moor C et al (2003) Psychosocial and demographic predictors of quality of life in a large sample of cancer patients. Psychooncology 12:183–93

    PubMed  Article  Google Scholar 

  22. 22.

    Rottenberg Y, Litwin H, Manor O et al (2014) Prediagnostic self-assessed health and extent of social networks predict survival in older individuals with cancer: a population based cohort study. J Geriatr Oncol 5:400–7

    PubMed  Article  Google Scholar 

  23. 23.

    Zimet GD, Powell SS, Farley GK et al (1990) Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. J Pers Assess 55:610–7

    PubMed  CAS  Article  Google Scholar 

  24. 24.

    Sloan J, Symonds T, Vargas-Chanes D, Fridley B (2003) Practical guidelines for assessing the clinical significance of health-related quality of life changes within clinical trials. Drug Inf J 37:23–31

    Google Scholar 

  25. 25.

    Saussele S, Krauss MP, Hehlmann R et al (2015) Impact of comorbidities on overall survival in patients with chronic myeloid leukemia: results of the randomized CML study IV. Blood 126:42–9

    PubMed  CAS  PubMed Central  Article  Google Scholar 

  26. 26.

    Vissers PA, Thong MS, Pouwer F et al (2013) The impact of comorbidity on health-related quality of life among cancer survivors: analyses of data from the PROFILES registry. J Cancer Surviv 7:602–13

    PubMed  CAS  Article  Google Scholar 

  27. 27.

    Smith SK, Mayer DK, Zimmerman S et al (2013) Quality of life among long-term survivors of non-Hodgkin lymphoma: a follow-up study. J Clin Oncol 31:272–9

    PubMed  PubMed Central  Article  Google Scholar 

  28. 28.

    Korszun A, Sarker SJ, Chowdhury K et al (2014) Psychosocial factors associated with impact of cancer in longterm haematological cancer survivors. Br J Haematol 164:790–803

    PubMed  Article  Google Scholar 

  29. 29.

    Efficace F, Baccarani M, Breccia M et al (2013) Chronic fatigue is the most important factor limiting health-related quality of life of chronic myeloid leukemia patients treated with imatinib. Leukemia 27:1511–9

    PubMed  CAS  Article  Google Scholar 

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We are deeply grateful to all patients who participated in this study. We also thank Alessandro Perreca (from GIMEMA Data Center) for his assistance with data management and administrative support throughout the study period.

Authors’ contributions

FE, MB, MBA, and GR did the conception and design of this study. FC and FE completed the statistical analysis. FE, FC, GR, and MB carried out manuscript writing. All authors did the collection and assembly of data and the final approval of manuscript.

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Corresponding author

Correspondence to F. Efficace.

Ethics declarations

Ethic committees of participating centers approved the study. All patients provided written informed consent.


This study was funded by the “Associazione Italiana contro le Leucemie, Linfomi e Mieloma (AIL)”.

The work of Johannes M. Giesinger has been funded by a grant from the Austrian Science Fund (FWF J3353).

Conflict of interest

The authors declare that they have no conflict of interest.

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Efficace, F., Rosti, G., Breccia, M. et al. The impact of comorbidity on health-related quality of life in elderly patients with chronic myeloid leukemia. Ann Hematol 95, 211–219 (2016).

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  • Comorbidity
  • Quality of life
  • Chronic myeloid leukemia