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Correlates of fatigue severity in patients with chronic myeloid leukemia treated with targeted therapy



Tyrosine kinase inhibitors (TKIs) substantially improve survival for patients with chronic myeloid leukemia (CML), but fatigue associated with TKIs can negatively impact patients’ quality of life and adherence. This study sought to identify correlates of fatigue (e.g., sociodemographic characteristics, clinical characteristics, health behaviors) among patients with CML taking TKIs who reported moderate to severe fatigue.


Adults with CML experiencing at least moderate fatigue were recruited for a pilot trial of a cognitive behavioral intervention to improve fatigue. Data collected pre-intervention were used to explore concurrent correlates of fatigue in univariate and multivariable models.


Participants (N = 44, 48% female) were M = 55.6 years old (SD = 12.6) and had been diagnosed with CML M = 5.2 years prior (SD = 5.3). Participants had been taking their current TKI for M = 2.5 years (SD = 2.7). Most participants (64%) had previously been treated with ≥ 1 other TKI. More than three-quarters of participants (77%) reported severe fatigue. In univariate models, worse fatigue was associated with higher BMI (r = -0.36, p = 0.018), prior treatment with other TKI(s) (r =  − 0.34, p = 0.024), worse sleep disturbance (r =  − 0.51, p < 0.001), and less physical activity (r = 0.31, p = 0.043). In a multivariable model, significant univariate correlates accounted for 39% of the variance in fatigue. Worse fatigue remained significantly correlated with higher BMI (β =  − 0.33, p = 0.009) and more disturbed sleep (β =  − 0.45, p < 0.001).


Results may inform future research aiming to identify fatigued patients with CML at risk for experiencing more severe fatigue during TKI therapy. Identifying predictors of fatigue severity could aid clinicians in identifying which patients will benefit from referrals to supportive therapy.

Trial registration: NCT02592447, October 30, 2015

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Code availability

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This study was funded by the National Cancer Institute (R21-CA191594 and P30-CA076292); the views expressed are those of the authors and do not necessarily represent those of the National Cancer Institute. This work was also supported in part by the Population Research, Interventions, and Measurement Core Facility at the H. Lee Moffitt Cancer Center and Research Institute, a National Cancer Institute-designated comprehensive cancer center.

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Authors and Affiliations



LBO: conceptualization, writing-original draft, writing-review and editing; KAH: formal analysis, data curation, writing-original draft, writing-review and editing; SLE: formal analysis, data curation, writing-original draft, writing-review and editing; AIH: data curation, writing-original draft, writing-review and editing; HK: writing-review and editing; AMN: writing-review and editing; JP-I: writing-review and editing; KS: writing-review and editing; PBJ: conceptualization, writing-review and editing, funding acquisition; HSLJ: conceptualization, writing-review and editing, funding acquisition.

Corresponding author

Correspondence to Laura B. Oswald.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Chesapeake Institutional Review Board (Pro00023476).

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Informed consent to participate was obtained from all individual participants included in this study.

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All participants consented to having de-identified and aggregate study data published.

Conflicts of interest

Dr. Jim is a paid consultant for RedHill BioPharma, Janssen Scientific Affairs, and Merck. The other authors have no relevant conflicts of interest.

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Oswald, L.B., Hyland, K.A., Eisel, S.L. et al. Correlates of fatigue severity in patients with chronic myeloid leukemia treated with targeted therapy. Support Care Cancer 30, 87–94 (2022).

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  • Chronic myeloid leukemia
  • Fatigue
  • Health behavior
  • Psycho-oncology
  • Quality of life