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Acute promyelocytic leukaemia long-term survivors: higher fatigue and greater overall symptom burden
  1. Kathrin Sommer1,
  2. Marco Vignetti1,
  3. Francesco Cottone1,
  4. Massimo Breccia2,
  5. Ombretta Annibali3,
  6. Mario Luppi4,
  7. Tamara Intermesoli5,
  8. Erika Borlenghi6,
  9. Paola Carluccio7,
  10. Francesco Rodeghiero8,
  11. Francesco Fabbiano9,
  12. Claudio Romani10,
  13. Marco Sborgia11,
  14. Bruno Martino12,
  15. Monica Crugnola13 and
  16. Fabio Efficace1
  1. 1 Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Roma, Italy
  2. 2 Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Roma, Italy
  3. 3 Hematology and Stem Cell Transplantation Unit, Campus Bio-Medico University, Roma, Italy
  4. 4 Department of Medical and Surgical Sciences, Section of Hematology, Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Modena, Italy
  5. 5 Hematology and BMT Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
  6. 6 Department of Hematology, ASST Spedali Civili, Brescia, Italy
  7. 7 Hematology Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
  8. 8 Hematology Project Foundation, Department of Hematology, San Bortolo Hospital, Vicenza, Italy
  9. 9 Division of Hematology and Bone Marrow Transplantation, Ospedali Riuniti Villa Sofia - Cervello, Palermo, Italy
  10. 10 UO Ematologia e Centro TMO, Ospedale Armando Businco, Cagliari, Italy
  11. 11 Department of Hematology, Bone Marrow Transplant Center, Pescara, Italy
  12. 12 Hematology Unit, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
  13. 13 Hematology, Parma University, Parma, Italy
  1. Correspondence to Dr Fabio Efficace, Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Roma, Italy; f.efficace{at}


Objective We aimed to investigate the association of fatigue with severity of other key cancer symptoms, as well as symptom interference with daily activities and outlook on life, in long-term survivors of acute promyelocytic leukaemia (APL).

Methods The study sample consisted of APL survivors (n=244), with a median time from diagnosis of 14.3 years (IQR=11.1–16.9 years), previously enrolled in a long-term follow-up study. Symptom severity and symptom interference were assessed using the well-validated MD Anderson Symptom Inventory (MDASI). Fatigue was evaluated with the Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire.

Results Higher fatigue burden was associated with increased affective symptoms, memory problems, drowsiness, sleep disturbances, shortness of breath and pain. Higher levels of fatigue were also associated with higher scores across all interference items of the MDASI. Overall, symptoms interfered most with mood, but among APL survivors with high levels of fatigue, symptoms interfered most with enjoyment of life. Multivariable regression analysis confirmed the independent association between fatigue and all symptom severity items of the MDASI.

Conclusions The current findings show that long-term APL survivors who report higher fatigue also experience a greater overall symptom burden and a substantial impact on performance of daily activities. Further studies are needed to examine whether interventions aimed at reducing fatigue could also reduce overall symptom burden.

  • leukaemia
  • fatigue
  • quality of life
  • survivorship

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  • Contributors FE and FC contributed to the design of the research study. FC and KS performed the analysis. KS prepared the first draft of the manuscript. KS, MV, FC, MB, OA, ML, TI, EB, PC, FR, FF, CR, MS, BM, MC and FE were involved in the interpretation of the results and have approved the final submitted version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests The following authors declare competing interests unrelated to this work: FE: consultancy for Amgen, Bristol Myers Squibb, Orsenix, and Takeda, and research grants (to his institution) from Amgen. FR: advisory board/speakers’ bureau for Amgen, Novartis and Argenx. MC: Novartis and Incyte. MB: honoraria by Novartis, Incyte, Pfizer and Celgene. ML: advisory board for Novartis, Gilead Sci, MSD, Jazz, Sanofi, Daiichi Sankyo and AbbVie, and travel grant (Gilead Sci). EB: consultancy for Amgen and Celgene. MV: personal fees from Jazz Healthcare Italy, Amgen, Millennium Pharmaceuticals, Celgene, Janssen, Novartis and Incyte.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.