Age, Obesity, Comorbidities Linked with Severe Fatigue Among Non-Hodgkin’s Lymphoma Survivors

While a significant proportion of non-Hodgkin’s lymphoma survivors suffer from severe fatigue, the type of initial treatment and Rituxan (rituxumab) use did not influence this outcome, a new study shows. Instead, severe fatigue was found to be correlated with increased age, obesity, and the presence of other comorbidities.

The study, “Long-Term Fatigue in Survivors of Non-Hodgkin Lymphoma: The Lymphoma Study Association SIMONAL Cross-Sectional Study,” was published in the journal Cancer.

The clinical outcomes of patients with non-Hodgkin’s lymphoma have improved significantly over time. In particular, the efficacy of Rituxan has made it an attractive therapeutic candidate to add to existing treatment regimens.

Unfortunately, non-Hodgkin’s lymphoma survivors suffer in the long term from various toxicities and fatigue. Fatigue affects approximately 30% of all types of cancer survivors.

With higher remission rates and survival time, it is now important to judge how well patients do in the long term after exposure to these therapies. However, there is little data on fatigue and details regarding rehabilitation during the post-Rituxan follow-up period.

The Lymphoma Study Association (LYSA) is a network of more than 100 centers that cooperate to provide data on non-Hodgkin’s lymphoma treatment with new agents and intensification strategies. To date, almost 10,000 patients have been involved in LYSA studies.

Using data from the LYSA database, researchers conducted a cross-sectional study to investigate the health status of survivors after a median follow-up of 11 years after treatment of lymphoma. Scientists specifically focused on fatigue and health disorders.

Researchers analyzed results from two self-administered questionnaires, the 20-item Multidimensional Fatigue Inventory (MFI-20) and a Life Situation Questionnaire. These questionnaires were administered in 2015 to non-Hodgkin’s lymphoma survivors who were part of several clinical studies from 1993-2010.

Among the 3,317 survivors asked to participate, 1,671 (50%) returned the questionnaires. Researchers defined severe fatigue as an MFI-20 score of 60 or more. Next, researchers used a statistical model to assess which factors were linked to increased fatigue levels.

The study population was composed of 906 men and 765 women, with a median age of 64 years. Most had diffuse-large B-cell lymphoma (70%), while the remaining had either follicular lymphoma (28%) or T-cell lymphoma (2%).

Overall, 811 survivors had received a standard chemotherapy treatment called CHOP, which stands for cyclophosphamide, doxorubicin, vincristine, prednisone. Among these patients, 518 received high-dose CHOP and 342 had undergone upfront autologous stem cell transplantation (a treatment in which stem cells are collected from the patient and returned after high-dose chemotherapy). Overall, 829 survivors had received Rituxan.

Among the participants, 1,100 (66%) reported one or more health disorders in the long term. Specifically, 602 (37%) reported severe fatigue.

“These results confirm the belief shared by most hematologists that [non-Hodgkin’s lymphoma] survivors have altered health status over time, with three-quarters of the study population reporting symptomatic fatigue,” investigators said.

When looking at factors contributing to the development of fatigue in these lymphoma survivors, researchers found a significant correlation between fatigue levels and age, obesity, and presence of other health disorders. Interestingly, there was no correlation with type of initial treatment or use of Rituxan.

“Our results suggest that long-term fatigue is independent of disease characteristics (including histologic type), initial treatment, as well as treatment for recurrent disease; whereas obesity and comorbidities play a role in the development of fatigue that persists or develops early after treatment completion,” researchers concluded.