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Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Efficace F, Gaidano G, Breccia M, et al. Prognostic value of self-reported fatigue on overall survival in patients with myelodysplastic syndromes: a multicentre, prospective, observational, cohort study. Lancet Oncol 2015; published online Sept 22. http://dx.doi.org/10.1016/s1470-2045(15)00206-5.

APPENDIX ONLINE Supplementary Table 1. Distribution of hemoglobin levels by patients self-reported baseline fatigue. Self-reported levels of fatigue (EORTC QLQ-C30) Hemoglobin (g/dl) Mean (SD) 0 9.79 (1.68) 11 10.31 (2.24) 22 10.05 (1.69) 33 9.27 (1.70) 44 9.18 (2.58) 55 8.99 (1.47) 66 9.04 (2.01) 77 9.24 (1.43) 88 8.87 (2.10) 100 8.31 (1.12) Abbreviations: EORTC QLQ-C30, European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire-Core 30, SD, standard deviation. Legend : the table shows the distribution of mean hemoglobin levels according to the observed scores of patients self-reported fatigue scale of EORTC QLQ-C30 questionnaire. Fatigue scores of the EORTC QLQ-C30 range between 0 and 100, with higher scores indicating higher level of fatigue. 1

APPENDIX ONLINE General list of participating centers and Investigators involved: Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont. Novara, (Gianluca Gaidano, Monia Lunghi, Clara De Ambrogi) Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, (Giuliana Alimena, Massimo Breccia, Maria Pia Loglisci) Department of Hematology, University of Rome Cattolica S. Cuore. Rome, (Maria Teresa Voso, Marianna Criscuolo) Department of Medical Sciences, University of Cagliari. Cagliari, (Giorgio La Nasa, Giovanni Caocci) Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University. Innsbruck, Austria (Reinhard Stauder, Britta Halter) Ematologia e Centro Trapianti. Ospedale Oncologico di Riferimento Regionale Armando Businco. Cagliari, (Emanuele Angelucci, Anna Angela Di Tucci) Department of Haematology, AZ St Jan Brugge-Oostende, Belgium (Dominik Selleslag, Tina Ducheyne) Department of Hematology and Stem Cell Transplantation Unit, IRCCS Casa Sollievo della Sofferenza Hospital. San Giovanni Rotondo, (Nicola Cascavilla, Grazia Sanpaolo) Department of Medicine I, University hospital Dresden Carl Gustav Carus. Dresden, Germany (Uwe Platzbecker, Susann Pinkert, Susann Knack) Department of Medicine, Department of Haematology, General University Hospital, Charles University, Prague, Czech Republic (Anna Jonasova) Department of Internal Medicine, CHU Toulouse, Institut Universitaire du Cancer de Toulouse - Oncopole, 1 avenue I. Joliot-Curie, 31059 Toulouse Cedex 9, France (Odile Beyne-Rauzy, Nicolas Ferrieres) Hematology, Department of Biomedicine and Prevention, Tor Vergata University. Rome, (Sergio Amadori, Francesco Buccisano) Department of Emergency and Organ Transplantation, Hematology Section, University of Bari. Bari, (Giorgina Specchia, Alessandra Ricco) UO Ematologia, AOU Policlinico-V.Emanuele. Catania, (Giuseppe Palumbo, Elena Schinocca, Marco Ragusa) St James s Institute of Oncology, Bexley Wing. Leeds, UK (David Bowen, Ayna Beden) Leukemia Department. The University of Texas MD Anderson Cancer Center. Texas, Houston, USA (Khanh Nguyen, Guillermo Garcia-Manero, Christina Meyers) Department of Haematology, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine. Shenyang, China (Huiyong Zhang) School of Humanities and Management, Guangdong Medical College. Dongguan, China (Chonghua Wan, Yang Zheng) Hematology Unit, S. Eugenio Hospital, Rome, (Pasquale Niscola, Andrea Tendas, Luca Cupelli) 2

Department of Haematology, S. Giovanni-Addolorata Hospital. Rome, (Luciana Annino, Susanna Fenu) Department of Internal Medicine I, University of Freiburg Medical Centre. Freiburg, Germany (Michael Lübbert, Johannes Waldschmidt) Department of Oncology-Hematology, Hospital Center Pugliese-Ciaccio. Catanzaro, (Luciano Levato, Stefano Molica, Maria Lentini) Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation. Pavia, (Carlo Balduini, Rosangela Invernizzi) Complex Operative Hematology and Transplantation Unit, Lecce Local Health Service, Lecce, (Nicola Di Renzo, Claudia Quintavalle) Department of Public Health, College of Public Health, National Taiwan University, Roosevelt Road. Taipei, Taiwan, Republic of China (Weichu Chie) Department of Haematology, Bradford Institute of Health Research. Bradford, UK (Sam Ackroyd, Victoria Drew) Division of Regenerative Medicine, Stem Cells and Gene Therapy, San Raffaele Scientific Institute. Milan, (Fabio Ciceri) Oncology Department, CHC Clinique Saint-Joseph. Liège, Belgium (Christian Focan) Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York. New York, USA (Stephen Nimer, Virginia Klimek, Emily Dolezal) Department of Haematology, AZ Middelheim. Antwerp, Belgium (Robrecht De Bock, Jan Christiaens) Department of Haematology, Hospital de Jolimont. La Louviere, Belgium (Christophe Ravoet, Petre Helene) Istituto Oncologico Romagnolo per la Cura dei Tumori. Meldola, (Maria Benedetta Giannini, Francesca Fabbri) Haematology Unit, Sapienza University, Polo Pontino. Latina, (Sergio Mecarocci) Department of Haematology, University Campus Bio-medico, Roma, (Giuseppe Avvisati, Carolina Nobile) Division of Hematology, Niguarda Ca' Granda Hospital. Milano, (Enrica Morra) Division of Hematology, Università di Torino, Ospedale San Giovanni Battista. Torino, (Giorgia Matta) Department of Onco-hematology, S. Maria della Misericordia Hospital. Rovigo, (Rossella Paolini) 3

List of participating centers and Principal Investigators by patients included: PARTICIPATING CENTRE Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont. Novara, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Department of Hematology, University of Rome Cattolica S. Cuore. Rome, Department of Medical Sciences, University of Cagliari. Cagliari, Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University. Innsbruck, Austria Ematologia e Centro Trapianti. Ospedale Oncologico di Riferimento Regionale Armando Businco. Cagliari, Department of Haematology, AZ St Jan Brugge-Oostende, Belgium Department of Hematology and Stem Cell Transplantation Unit, IRCCS Casa Sollievo della Sofferenza Hospital. San Giovanni Rotondo, Department of Medicine I, University hospital Dresden Carl Gustav Carus. Dresden, Germany Department of Medicine, Department of Haematology, General University Hospital, Charles University, Prague, Czech Republic Department of Internal Medicine, CHU Toulouse, Institut Universitaire du Cancer de Toulouse - Oncopole, 1 avenue I. Joliot-Curie, 31059 Toulouse Cedex 9, France Hematology, Department of Biomedicine and Prevention, Tor Vergata University. Rome, Department of Emergency and Organ Transplantation, Hematology Section, University of Bari. Bari, PRINCIPAL INVESTIGATOR RECRUITED PATIENTS PER CENTRE Gianluca Gaidano 40 Giuliana Alimena 29 Maria Teresa Voso 26 Giorgio La Nasa 24 Reinhard Stauder 16 Emanuele Angelucci 15 Dominik Selleslag 13 Nicola Cascavilla 11 Uwe Platzbecker 10 Anna Jonasova 8 Odile Beyne-Rauzy 7 Sergio Amadori 7 Giorgina Specchia 7 UO Ematologia, AOU Policlinico-V.Emanuele. Catania, Giuseppe Palumbo 6 St James s Institute of Oncology, Bexley Wing. Leeds, UK. David Bowen 6 4

Leukemia Department. The University of Texas MD Anderson Cancer Center. Texas, Houston, USA Department of Haematology, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, China School of Humanities and Management, Guangdong Medical College. Dongguan, China Khanh Nguyen 6 Huiyong Zhang 5 Chonghua Wan 5 Hematology Unit, S. Eugenio Hospital, Rome, Pasquale Niscola 5 Department of Haematology, S. Giovanni-Addolorata Hospital. Rome, Department of Internal Medicine I, University of Freiburg Medical Centre. Freiburg, Germany Department of Oncology-Hematology, Hospital Center Pugliese- Ciaccio. Catanzaro, Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation. Pavia, Complex Operative Hematology and Transplantation Unit, Lecce Local Health Service, Lecce, Department of Public Health, College of Public Health, National Taiwan University, Roosevelt Road. Taipei, Taiwan, Republic of China Department of Haematology, Bradford Institute of Health Research. Bradford, UK Division of Regenerative Medicine, Stem Cells and Gene Therapy, San Raffaele Scientific Institute. Milan, Oncology Department, CHC Clinique Saint-Joseph. Liège, Belgium Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York. New York, USA Luciana Annino 4 Michael Lübbert 4 Luciano Levato 3 Carlo Balduini 3 Nicola Di Renzo 2 Weichu Chie 2 Sam Ackroyd 2 Fabio Ciceri 2 Christian Focan 2 Stephen Nimer 2 Department of Haematology, AZMiddelheim. Antwerp, Belgium Robrecht De Bock 1 Department of Haematology, Hospital de Jolimont. La Louviere, Belgium Istituto Oncologico Romagnolo per la Cura dei Tumori. Meldola, Haematology Unit, Sapienza University, Polo Pontino. Latina, Department of Haematology, University Campus Bio-medico, Roma, Christophe Ravoet 1 Maria Benedetta Giannini 1 Sergio Mecarocci 1 Giuseppe Avvisati 1 5

Division of Hematology, Niguarda Ca' Granda Hospital. Milano, Division of Hematology, Università di Torino, Ospedale San Giovanni Battista. Torino, Department of Onco-hematology, S. Maria della Misericordia Hospital. Rovigo,. Enrica Morra 1 Giorgia Matta 1 Rossella Paolini 1 6