P1677: defining key quality of life metrics in acute myeloid leukaemia and high risk myelodysplastic syndrome patients enrolled in large-scale uk ncri aml trials

Topic: 35. Quality of life and palliative care Background: For most high risk myelodysplastic syndrome (HR MDS) patients, treatment is mainly life-prolonging; intensive/non-intensive chemotherapy may be clinically meaningful, with impact on Quality of Life (QoL), even if not curative. Whether specific metrics within standardised QoL tools relate to disease severity in HR MDS or Acute Myeloid Leukaemia (AML) is poorly understood. Aims: 1.To understand if pre-treatment QoL scores correlate with disease severity in patients undergoing intensive or non-intensive chemotherapy 2.To determine whether baseline QoL scores differed between HR MDS/AML patients who underwent treatment with intensive vs non-intensive chemotherapy Methods: Patients enrolled onto the NCRI AML18 and LI-1 trials (which respectively evaluated intensive and non-intensive chemotherapy in older MDS/AML patients) completed QoL questionnaires (EORTC QLQ-C30, EQ5D and the Hospital Anxiety and Depression Score (HADS)) at baseline, 3, 6 and 12 months. Patients were classified as HR MDS (10-19% BM blasts) or low blast percentage AML (20-30% BM blasts) to assess the impact of disease severity on QoL scores. Binary variables were compared using Pearson’s chi-square test; continuous variables were compared using the Mann-Whitney test. Linear regression analyses assessed treatment/disease severity effects. Results: Baseline QoL scores were available for 451 AML18 patients and 299 LI1 subjects. Data were available for 206 patients with 10-19% BM blasts and 245 patients with 20-30% BM blasts treated on AML18 and 110 (10-19% BM blasts) and 189 (20-30% blasts) LI1 subjects. AML18 and LI1 patients were well-matched for demographic factors. 82% of patients in AML18 had a HCT-CI score of 2 or less; as expected, this was the case for only 71% of LI-1 patients (p=0.002). Neither HADS nor EQ5D scores highlighted differences in results according to treatment intensity or disease severity. Notably, this included no evidence of heightened anxiety or depression in subjects at baseline. In the EORTC-QLQ-C30 for AML18, after adjustment for age, gender, BMI and HCT-CI, AML patients reported significantly more appetite loss (adjusted severity effect (ASE) 6.83, standard error (SE) 3.47 and p=0.05), diarrhoea (ASE 6.05, SE 2.44, p=0.014) and financial difficulties (ASE 6.05, SE 2.44, p=0.014) compared with patients with HRMDS (Table 1). No significant effects of disease severity on baseline QoL scores were seen within the LI1 cohort. EORTC-QLQ-C30 physical functioning (ASE -9.21 (SE 4.04), p=0.023) was noted to be significantly worse for LI1 compared with AML18 subjects, indicating that clinician perception of suitability for intensive chemotherapy aligned with this patient reported metric. Summary/Conclusion: For the first time, we highlight specific differences in baseline QoL between patients with HR MDS/AML selected for intensive/non-intensive chemotherapy. Standard QoL tools were discriminatory in patients selected for intensive chemotherapy according to disease severity, but not in LI1 patients, perhaps reflecting minimal signal difference due to confounding factors such as comorbidity and ageing. This may lend support to the importance of using QoL tools specifically designed for HR MDS/AML patients in future NCRI AML trials of older patients.Keywords: Chemotherapy, Myelodysplastic syndrome, Quality of life, Acute myeloid leukemia