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
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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; Schetelig On Behalf Of The Chronic Malignancies Working Party Of The Ebmt And The Uk Medical Research Council, Johannes.
in: AM J HEMATOL, Jahrgang 89, Nr. 2, 01.02.2014, S. 174-80.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - 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
AU - de Wreede, Liesbeth C
AU - Watson, Maggie
AU - van Os, Marleen
AU - Milligan, Donald
AU - van Gelder, Michel
AU - Michallet, Mauricette
AU - Dreger, Peter
AU - Dearden, Claire E
AU - Homewood, Janis
AU - Dupuis, Jehan
AU - Leporrier, Michel
AU - Karas, Michal
AU - Corront, Bernadette
AU - Baerlocher, Gabriela M
AU - Herr, Wolfgang
AU - Choquet, Sylvain
AU - Niederwieser, Dietger W
AU - Sutton, Laurent
AU - Kröger, Nicolaus
AU - de Witte, Theo M
AU - Schetelig On Behalf Of The Chronic Malignancies Working Party Of The Ebmt And The Uk Medical Research Council, Johannes
N1 - Copyright © 2013 Wiley Periodicals, Inc.
PY - 2014/2/1
Y1 - 2014/2/1
N2 - 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.
AB - 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.
KW - Adult
KW - Aged
KW - Antineoplastic Combined Chemotherapy Protocols
KW - Female
KW - Hematopoietic Stem Cell Transplantation
KW - Humans
KW - Leukemia, Lymphocytic, Chronic, B-Cell
KW - Male
KW - Middle Aged
KW - Quality of Life
KW - Questionnaires
KW - Recurrence
KW - Transplantation Conditioning
KW - Transplantation, Autologous
U2 - 10.1002/ajh.23610
DO - 10.1002/ajh.23610
M3 - SCORING: Journal article
C2 - 24123244
VL - 89
SP - 174
EP - 180
JO - AM J HEMATOL
JF - AM J HEMATOL
SN - 0361-8609
IS - 2
ER -