Relationship among chelator adherence, change in chelators, and quality of life in thalassemia

Abstract

Purpose: Thalassemia, a chronic blood disease, necessitates life-long adherence to blood transfusions and chelation therapy to reduce iron overload. We examine stability of health-related quality of life (HRQOL) in thalassemia and adherence to chelation therapy over time, especially after changes in chelator choice.

Methods: Thalassemia Longitudinal Cohort participants in the USA, UK, and Canada completed the SF-36v2 (ages 14+) and the PF-28 CHQ (parents of children <14 years). Chelation adherence was defined as self-reported percent of doses administered in the last 4 weeks.

Results: Two hundred and fifty-eight adults/adolescents (mean 29.7 years) and 133 children (mean 8.5 years) completed a mean of 2.8-years follow-up. Children made few chelator changes, whereas a mean of 2.2 changes was observed among the 37% of adults/adolescents who made chelator changes, mainly due to patient preference or medical necessity. Physical HRQOL improved among those with lower iron burden (better health status) at baseline who made a single change in chelator, but declined among participants with multiple changes and/or high iron burden (worse health status). Mental health improved among participants with lower iron burden, but iron overload was negatively associated with social functioning. Adherence did not significantly change over follow-up except for an increase after a change from deferoxamine (DFO) infusion to oral deferasirox (p = 0.03). Predictors of lower adherence for adults/adolescents at follow-up included side effects, smoking, younger age, problems preparing DFO, increased number of days per week DFO prescribed, and lower physical quality of life .

Conclusions: Strategies to balance medical needs with family, work, and personal life may assist in adherence.

Fig. 1

Summary of (a) HRQOL and (b) adherence over the lifespan of a thalassemia patient.

Fig. 1

Summary of (a) HRQOL and (b) adherence over the lifespan of a thalassemia patient.

Fig. 2

Adherence (a), change in SF-36 QOL physical (b) and mental scales (c), and HADS anxiety and depression (d) by number of chelator changes and baseline ferritin

Fig. 3

Percent of participants with clinically meaningful decrease (− 2 points), no change, or increase (+2 points) from baseline to 1-year follow-up in (a) SF-36 QOL scales for adults/adolescents (age 14+) and (b) CHQ QOL scales for children (<14 years)