The anemia-independent impact of myelodysplastic syndromes on health-related quality of life

PURPOSE
Myelodysplastic syndromes (MDS) are in the majority of cases characterized by anemia. Both anemia and MDS per se may directly contribute to impairments in health-related quality of life (HRQoL). In this study, we aimed to investigate the anemia-independent impact of MDS on HRQoL.
METHODS
We evaluated participants (≥50 years) from the large population-based Lifelines cohort (N=44694, mean age 59.0±7.4, 43.6% male) and the European MDS Registry (EUMDS) (N=1538, mean age 73.4±9.0, 63.0% male), which comprises a cohort of lower-risk MDS patients. To enable comparison concerning HRQoL, SF-36 scores measured in Lifelines were converted to EQ-5D-3L index (range 0-1) and dimension scores.
RESULTS
Participants from EUMDS had significantly lower HRQoL than those from the Lifelines cohort, as illustrated in both the index score and in the five different dimensions. Multivariable linear regression analysis demonstrated that MDS had an adjusted total impact on the EQ-5D index score (B=-0.12, β=-0.24, p<0.001) and an anemia-independent ‘direct’ impact (B=-0.10, β=-0.21, p<0.001). Multivariable logistic regression analysis revealed an anemia-independent impact of MDS in the dimensions mobility, self-care, usual activities and anxiety/depression (all except pain/discomfort).
CONCLUSION
This study demonstrates that the major part of the negative impact of lower-risk MDS on HRQoL is not mediated via anemia. Thus, treatment interventions directed at underlying pathogenic mechanisms might be integrated, rather than aiming predominantly at increasing hemoglobin levels to improve HRQoL.