Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Endocrinology, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, The Netherlands.
Ann Hematol. 2021 Dec;100(12):2921-2932. doi: 10.1007/s00277-021-04654-1. Epub 2021 Sep 2.
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. We evaluated participants (≥ 50 years) from the large population-based Lifelines cohort (N = 44,694, mean age 59.0 ± 7.4 years, 43.6% male) and the European MDS Registry (EUMDS) (N = 1538, mean age 73.4 ± 9.0 years, 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. Lower-risk MDS patients 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, p < 0.001) and an anemia-independent "direct" impact (B = - 0.10, p < 0.001). Multivariable logistic regression analysis revealed an anemia-independent impact of MDS in the dimension mobility, self-care, usual activities, and anxiety/depression (all except pain/discomfort). This study demonstrates that the major part of the negative impact of lower-risk MDS on HRQoL is not mediated via anemia. Thus, the therapeutic focus should include treatment strategies directed at underlying pathogenic mechanisms to improve HRQoL, rather than aiming predominantly at increasing hemoglobin levels.
骨髓增生异常综合征（MDS）在大多数情况下以贫血为特征。贫血和 MDS 本身都可能直接导致健康相关生活质量（HRQoL）受损。在这项研究中，我们旨在研究 MDS 对 HRQoL 的贫血无关影响。我们评估了来自大型基于人群的 Lifelines 队列（N=44694，平均年龄 59.0±7.4 岁，43.6%为男性）和欧洲 MDS 登记处（EUMDS）（N=1538，平均年龄 73.4±9.0 岁，63.0%为男性）的参与者，后者包含一组低危 MDS 患者。为了能够就 HRQoL 进行比较，在 Lifelines 中测量的 SF-36 评分被转换为 EQ-5D-3L 指数（范围 0-1）和维度评分。低危 MDS 患者的 HRQoL 明显低于 Lifelines 队列中的患者，这在指数评分和五个不同维度中都有体现。多变量线性回归分析表明，MDS 对 EQ-5D 指数评分有调整后的总影响（B=-0.12，p<0.001），并且有与贫血无关的“直接”影响（B=-0.10，p<0.001）。多变量逻辑回归分析显示，MDS 在移动性、自我护理、日常活动和焦虑/抑郁维度（除疼痛/不适外）中存在与贫血无关的影响。这项研究表明，低危 MDS 对 HRQoL 的负面影响的主要部分不是通过贫血介导的。因此，治疗重点应包括针对潜在发病机制的治疗策略，以改善 HRQoL，而不是主要旨在提高血红蛋白水平。
