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Ferrata Storti Foundation
Haematologica 2021 Volume 106(7):1876-1882
Chronic Myeloid Leukemia
Fatigue in chronic myeloid leukemia patients on tyrosine kinase inhibitor therapy: predictors and the relationship with
physical activity
Lando Janssen,1,2 Nicole M.A. Blijlevens,2 Meggie M.C.M. Drissen,1 Esmée A. Bakker,1,3 Malou A.H. Nuijten,1 Jeroen J.W.M. Janssen,4 Silvie Timmers1,5 and Maria T.E. Hopman1
1
Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the Netherlands; 2Radboud Institute for Health Sciences, Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands; 3Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK; 4Cancer Center Amsterdam, Department
of Hematology, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands and 5Human and Animal Physiology, Wageningen University, Wageningen, the Netherlands
ABSTRACT
Fatigue is a common side effect of tyrosine kinase inhibitor (TKI) ther- apy in patients with chronic myeloid leukemia (CML). However, the prevalence of TKI-induced fatigue remains uncertain and little is known about predictors of fatigue and its relationship with physical activ- ity. In this study, 220 CML patients receiving TKI therapy and 110 gender- and age-matched controls completed an online questionnaire to assess fatigue severity and fatigue predictors (Part 1). In addition, physical activity levels were objectively assessed for 7 consecutive days in 138 severely fatigued and non-fatigued CML patients using an activity monitor (Part 2). We demonstrated that the prevalence of severe fatigue was 55.5% in CML patients and 10.9% in controls (P<0.001). We identified five predictors of fatigue in our CML population: age (odds ratio [OR] 0.96, 95% confidence interval [95% CI]: 0.93-0.99), female gender (OR 1.76, 95% CI: 0.92-3.34), Charlson Comorbidity Index (OR 1.91, 95% CI: 1.16-3.13), the use of comedication known to cause fatigue (OR 3.43, 95% CI: 1.58-7.44), and physical inactivity (OR of moderately active, vigorously active and very vigorously active compared to inactive 0.43 (95% CI: 0.12-1.52), 0.22 (95% CI: 0.06-0.74), and 0.08 (95% CI: 0.02-0.26), respectively). Objective mon- itoring of activity patterns confirmed that fatigued CML patients per- formed less physical activity of both light (P=0.017) and moderate to vigor- ous intensity (P=0.009). In fact, compared to the non-fatigued patients, fatigued CML patients performed 1 hour less of physical activity per day and took 2,000 fewer steps per day. Our findings facilitate the identification of patients at risk of severe fatigue and highlight the importance of setting reduction of fatigue as a treatment goal in CML care. This study was regis- tered at The Netherlands Trial Registry, NTR7308 (Part 1) and NTR7309 (Part 2).
Introduction
Survival of patients with chronic myeloid leukemia (CML) has improved signifi- cantly since the introduction of tyrosine kinase inhibitors (TKI) in 2001. This has translated into a life expectancy that is almost the same as that of the general popu- lation.1 Nevertheless, health-related quality of life (QoL) of CML patients is inferior to that of the general population, which is mainly the result of TKI-induced fatigue.2 CML patients require (potentially) lifelong treatment, which results in a persistent trigger for fatigue. Therefore, it is of the utmost importance to focus on prevention and management of fatigue in the care of CML patients. This is further supported by
Correspondence:
MARIA HOPMAN:
Maria.Hopman@radboudumc.nl
NICOLE BLIJLEVENS
Nicole.Blijlevens@radboudumc.nl
Received: January 17, 2020. Accepted: June 30, 2020. Pre-published: July 2, 2020.
https://doi.org/10.3324/haematol.2020.247767
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