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Clinical Trial
. 2019 Jul 1;37(19):1617-1628.
doi: 10.1200/JCO.18.01006. Epub 2019 Apr 10.

Patient-Reported Outcome Results From the Open-Label, Randomized Phase III Myeloma X Trial Evaluating Salvage Autologous Stem-Cell Transplantation in Relapsed Multiple Myeloma

Sam H Ahmedzai  1 , John A Snowden  2 , Andrew John Ashcroft  3 , David Allan Cairns  4 , Cathy Williams  5 , Anna Hockaday  4 , Jamie D Cavenagh  6 , Debo Ademokun  7 , Eleni Tholouli  8 , David Allotey  9 , Vijay Dhanapal  10 , Matthew Jenner  11 , Kwee Yong  12 , Jim Cavet  13 , Hannah Hunter  14 , Jennifer M Bird  15 , Guy Pratt  16 , Christopher Parrish  4 , Julia M Brown  4 , Treen C M Morris  17 , Gordon Cook  4 ; National Cancer Research Institute Haemato-Oncology Clinical Studies Group
Affiliations
Clinical Trial

Patient-Reported Outcome Results From the Open-Label, Randomized Phase III Myeloma X Trial Evaluating Salvage Autologous Stem-Cell Transplantation in Relapsed Multiple Myeloma

Sam H Ahmedzai et al. J Clin Oncol. .

Abstract

Purpose: Salvage autologous stem-cell transplantation (sASCT) in patients with multiple myeloma (MM) relapsing after a prior autologous stem-cell transplantation leads to increased remission duration and overall survival. We report a comprehensive study on patient-reported outcomes, including quality of life (QoL) and pain in sASCT.

Methods: Patients were randomly assigned to either sASCT or nontransplantation consolidation (NTC). Pain and QoL were assessed as secondary outcomes using validated QoL instruments (European Organisation for Research and Treatment of Cancer QLQ-C30 and myeloma-specific module, QLQ-MY20; the Brief Pain Inventory [Short Form]; and the Leeds Assessment of Neuropathic Symptoms and Signs [Self-Assessment] scale).

Results: A total of 288 patients (> 96%) consented to the QoL substudy. The median follow-up was 52 months. The European Organisation for Research and Treatment of Cancer QLQ-C30 Global health status scores were higher (better) in the NTC group at 100 days after random assignment (P = .0496), but not at later time points. Pain interference was higher (worse) in the sASCT group than in the NTC group at 6 months after random assignment (P = .0267), with patients with sASCT reporting higher scores for Pain interference with daily living for up to 2 years after random assignment. Patients reporting lower concerns about adverse effects of treatment after sASCT had a time to progression advantage.

Conclusion: Patients with sASCT with relapsed MM demonstrated a comparative reduction in QoL and greater impact of treatment adverse effects lasting for 6 months and up to 2 years for pain, after which patients who had received sASCT reported better outcomes. Patients who experienced lower adverse effects after sASCT had longer time to progression and overall survival, showing the need to improve symptom management peritransplantation. To our knowledge, this study provides the most comprehensive picture of QoL before and after sASCT in patients with relapsed MM.

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Figures

FIG 1.
FIG 1.
CONSORT diagram for Myeloma X study, including details of European Organisation for Research and Treatment of Cancer (EROTC) QLQ-C30 and MY20 questionnaire return. ASCT, autologous stem-cell transplantation; OS, overall survival; PBSC, peripheral-blood stem cell; QoL, quality of life; TTP, time to progression.
FIG 2.
FIG 2.
Baseline adjusted complete-case summary statistics (mean and 95% CI) scales from the European Organisation for Research and Treatment of Cancer (EROTC) QLQ-C30 questionnaire in randomly assigned patients. Global health status/quality of life (QoL)-social functioning: higher score represents better QoL/functioning; fatigue-body image loss: higher score represents worse symptoms/QoL. NTC, nontransplantation consolidation; sASCT, salvage autologous stem-cell transplantation.
FIG 3.
FIG 3.
Baseline adjusted complete-case summary statistics (mean and 95% CI) scales from the European Organisation for Research and Treatment of Cancer (EORTC)-QLQ-MY20 questionnaire in randomly assigned patients. Future perspective worries-body image loss: higher score represents worse symptoms/quality of life (QOL). NTC, nontransplantation consolidation; sASCT, salvage autologous stem cell transplantation.
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References

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