Restless legs syndrome in chronic myeloid leukemia: an overlooked condition with a significant impact on health-related quality of life

TL;DR

Restless legs syndrome is common in chronic myeloid leukemia patients and significantly affects their quality of life, even though it does not impact treatment response.

Contribution

This study identifies restless legs syndrome as an underrecognized comorbidity in chronic myeloid leukemia with significant impact on quality of life.

Findings

Restless legs syndrome affected 20.1% of chronic myeloid leukemia patients and 45.5% of those with iron deficiency.

Patients with RLS had worse sleep quality, higher anxiety, depression, and fatigue compared to those without RLS.

RLS did not affect treatment response but was linked to higher symptom burden scores.

Abstract

Restless legs syndrome (RLS) is a common but often overlooked cause of sleep disturbance and discomfort during rest. The prevalence of RLS remains unknown in chronic myeloid leukemia (CML). This study explores its frequency, clinical relevance, and impact on quality of life in patients with CML. We consecutively evaluated CML patients who visited our outpatient clinic between January and August 2023. Patients with iron deficiency (ID) and healthy subjects (HS) were also included as controls. Standardized psychometric assessments were administered to CML patients, including IRLSSG Rating Scale, Beck inventories, PSQI, FACIT-Fatigue, and EORTC QLQ-C30/CML24 for evaluating health-related quality of life (HRQoL). Neurological examinations and electromyography were performed in all participants diagnosed with RLS, including controls, to evaluate for secondary causes of peripheral polyneuropathy. A total of 164 CML patients, 22 individuals with ID, and 23 HSs were included. The rates of RLS were 20.1% and 45.5% in patients with CML and ID, respectively. None of the HS had RLS. Compared to non-RLS CML patients, those with RLS exhibited significantly poorer sleep quality (p = 0.016), greater anxiety (p < 0.001), depression (p = 0.005), and fatigue (p < 0.001), alongside elevated symptom burden scores (p < 0.001). Molecular responses and TKI dose modifications were similar between CML patients with and without RLS. Not using ACEi/ARB was associated with a 0.235-fold reduced risk of RLS, and a higher symptom burden score was independently associated with RLS (OR = 1.077). RLS is an underrecognized comorbidity in CML that severely impairs HRQoL, despite no impact on treatment response. Routine screening and targeted symptom management strategies are warranted.

The online version contains supplementary material available at 10.1007/s00277-026-06832-5.

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