Quality of Life of Patients with Non-Hodgkin's Lymphomas and Chronic Lymphocytic Leukemia, its Clinical and Laboratory Predictors and Association with Survival

Differences in survival outcomes of mature B-cell lymphoid neoplasms depending on patients' quality of life (QoL) are currently unknown. The purpose of the study was to investigate the QoL of patients with non-Hodgkin's lymphomas (NHL) and chronic lymphocytic leukemia (CLL) to establish its association with clinical and laboratory data, as well as its prognostic value. Material and methods. We examined 45 patients: 36 patients with NHL and 9 patients with CLL, aged 26-80 (a median is 60 years). A complete clinical and laboratory examination was conducted with the determination of blood lipids, proteins, inflammatory and coagulation markers. The questionnaire EORTC-QLQ-C30 was used for patients' QoL evaluation. During 35-months of follow-up period (a median is 23 months) overall survival (OS) and event-free survival (EFS) were analyzed using Kaplan-Meier method and Cox's F-test. Results and discussion. It was established that patients with NHL and CLL are characterized by low QoL, especially by low global health status/QoL and pronounced fatigue with a median score 50 of each (interquartile range 33.3-54.2 and 33.3-66.7, respectively). Clinical and laboratory predictors of low QoL included a higher disease stage and risk group, anemia, systemic inflammation, hypercoagulability, hypocholesterolemia and low levels of high density lipoprotein cholesterol (HDL-Ch). In particular, a score of physical functioning significantly correlated directly with blood levels of albumin (τ = 0.43, р = 0.039), and it correlated indirectly with levels of interleukin-6 (τ = -0.44, р = 0.002), fibrinogen (τ = -0.30, р = 0.039) and soluble fibrin-monomer complexes (τ = -0.32, р = 0.033). There were negative correlations between the ECOG score and hemoglobin (τ = -0.28, р = 0.008), HDL-Ch levels (τ = -0.21, р = 0.044). The low functional parameters and ECOG status were unfavorable prognostic factors for OS and EFS of these patients. The ECOG score of more than 1 point (2-4 points in 11 patients, 24.4%), which indicates low functional capacity of patients, was associated with significantly worse OS with cumulative proportion surviving (CPS) of 36.4% vs 73.3% in the case of ECOG 0 or 1 point (p = 0.010), as well as EFS CPS 18.2% vs 60.6%, respectively (p = 0.015). Survival in association with QoL parameters was estimated in 24 patients with follow-up period of 29 months (a median is 27 months). In the case of global health status/ QoL score less than 41.7 and more than 41.7, EFS CPS was 20.0% and 66.7%, respectively (p = 0.041). The physical functioning score less than 80 was associated with worse OS and EFS with CPS 41.7% vs 83.3% (p = 0,008) and 33.3% vs 62.5% (p = 0.023), respectively, in the cases of the score of more than 80. The cognitive functioning score less than 100 was associated with worse OS and EFS with CPS 45.5% vs 81.8% (p = 0,034) and 21.8% vs 72.7% (p = 0,016), respectively, in the cases of the score of 100. Conclusions. Patients with NHL and CLL are characterized by low QoL. Clinical and laboratory predictors of worse QoL of these patients are: advanced disease stage and higher risk group, anemia, systemic inflammation, hypercoagulability and dyslipidemia. Low scores of QoL function scales and ECOG status are adverse prognostic factors for OS and EFS of these patients. In clinical practice, it is advisable to evaluate QoL of patients with NHL and CLL to improve prognosis of their course.