MDS-Related Anemia Is Associated with Impaired Quality of Life but Improvement Is Not Always Achieved by Increased Hemoglobin Level

Abstract

Quality of life is impaired in MDS, but the role of hemoglobin level is unclear. To study the Hb-QoL correlation at diagnosis and 1 year later, patients filled out the EQ-5D questionnaire, assessing their mobility, self care, daily activities, pain/discomfort, and anxiety/depression, using scores of 0 (normal), 1 (mild/moderate), or 2 (poor). They also evaluated their health using a visual analogue scale, scoring from 0 (poor) to 100 (excellent). The anemia subgroups were: none/normal (Hb ≥ 12.5 g/dL), mild (10 ≤ Hb < 12.5), moderate (9 ≤ Hb < 10), severe (8 ≤ Hb < 9), or very severe (Hb < 8). LR-MDS patients (n = 127) and inpatient controls (n = 141) participated. The anemic patients had a poor QoL and the MDS patients had a lower QoL with a lower Hb. The controls had no QoL difference among the various anemia subgroups. In addition, the MDS QoL sharply decreased with an Hb of < 9. The MDS patients showed a wide QoL variability, i.e., different QoL scores in the same Hb subgroup, suggesting that other factors affect QoL (e.g., age and comorbidities). After 1 year (n = 61), the QoL was still poor for most MDS patients (including 27 patients with an increased Hb). In summary: (1) a poor QoL in MDS-anemia is non-linear, suggesting other influencing factors on QoL. (2) The sharp QoL drop with Hb < 9 g/dL challenges the transfusion Hb threshold. (3) The QoL in anemic MDS patients might differ from that in non-MDS patients. (4) Raising Hb, while recommended, does not guarantee an improved QoL.

Keywords: anemia; myelodysplastic neoplasms; myelodysplastic syndrome; quality of life; transfusion.

Figure 1

QoL scores (5 parameters) of the studied MDS patients. (A): The mean scores for the 5 subgroups: the mean EQ-5D scores were 0.12, 0.43, 0.48, 0.83, and 0.63 for normal, mild, moderate, severe, and very severe anemia, respectively. (B): The EQ-5D score for each individual patient, reflecting the large variability.

Figure 2

QoL scores (VAS) of the studied MDS patients. (A): The mean of the 5 various subgroups expressed as VAS score. (B): VAS score for each individual patient.

Figure 3

QoL VAS scores of non-MDS controls. While there is a difference in the VAS score between anemic and non-anemic patients, there is no significant difference among the anemic subgroups.

Figure 4

MDS patients, one year later. Individual Hb and QoL VAS scores 1 year after diagnosis for the 61 MDS patients for whom data were available. The right side represents an increased Hb level, and the left side a decreased Hb level. The upper part represents improved QoL (higher VAS score), while the lower part represents a declining QoL. Where the Hb decreased, 75% of them had a decreased VAS QoL score (left-lower quadrant, black dots); where the Hb increased, only 26% improved their QoL (right-upper quadrant, red dots). Please see text for details.