Longitudinal analysis of patient-reported symptoms post-autologous stem cell transplant and their relationship to inflammation in patients with multiple myeloma

Abstract

After autologous stem cell transplant (AuSCT), patients with multiple myeloma (MM) may receive lenalidomide maintenance therapy. This longitudinal study examined patient-reported symptom burden during the 3-9 months post-AuSCT and its association with maintenance therapy and circulating inflammatory markers. Fifty-one patients with MM rated symptom severity weekly using the MD Anderson Symptom Inventory MM module. When possible, blood for inflammatory marker assay was drawn at enrollment. Trajectory analysis identified clusters of patients who consistently reported higher or lower symptom severity. Although disease was relatively stable 3-9 months post-AuSCT, patients were not symptom-free: 35% were in the high-symptom group. Fatigue, pain, numbness/tingling, bone aches and muscle weakness were the most severe symptoms. Controlled for clinical variables, elevated baseline tumor necrosis factor-α (TNF-α) predicted high-symptom group membership (p = 0.014). Maintenance therapy and tumor response were not related to high symptom burden. Associations between inflammation and symptom burden in this exploratory study warrant further confirmatory study.

Keywords: MD Anderson Symptom Inventory (MDASI); Symptom; inflammation; maintenance therapy; multiple myeloma; patient-reported outcome (PRO).

Figure 1

High-symptom versus low-symptom group membership in patients with multiple myeloma 3–9 months after autologous stem cell transplant (n = 51) Abbreviation: MDASI-MM, MD Anderson Symptom Inventory multiple myeloma module.

Figure 2

TNF-α concentrations by symptom-severity group membership* *Wilcoxon rank sum test comparing the means of the marker values between groups.