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. 2021 Jan;29(1):467-475.
doi: 10.1007/s00520-020-05493-y. Epub 2020 May 11.

Symptom burden and its functional impact in patients with "symptomatic" relapsed or refractory multiple myeloma

Mona Kamal  1   2 , Xin Shelley Wang  3 , Qiuling Shi  1 , Teresa M Zyczynski  4 , Catherine Davis  4 , Loretta A Williams  1 , Hui-Kai Lin  1 , Araceli Garcia-Gonzalez  1 , Charles S Cleeland  1 , Robert Orlowski  5
Affiliations

Symptom burden and its functional impact in patients with "symptomatic" relapsed or refractory multiple myeloma

Mona Kamal et al. Support Care Cancer. 2021 Jan.

Abstract

Purpose: Relapsed or refractory multiple myeloma (RRMM) is labeled "symptomatic" based on laboratory values, but not relevant to quantitative measure of patient's perspectives. This study aimed to describe symptom burden, health status, and quality of life in RRMM patients.

Methods: The cross-sectional study included 184 MM patients (141 RRMM cases and 43 MM patients on follow-up without diagnosis/treatment of RRMM disease as controls), while 64 RRMM patients also provided longitudinal patient-reported outcomes (PROs) data. Symptomatic status was based on clinical measures of disease activity. PROs included the MD Anderson Symptom Inventory multiple myeloma module (MDASI-MM), single-item quality of life (SIQOL), and EuroQol-5D (EQ-5D). Wilcoxon rank test and effect size were used for comparisons. Regression models were used to describe symptom trajectory and to identify predictors of high symptom burden during 3 months of RRMM therapy.

Results: Most patients were clinically identified as symptomatic (93%). RRMM patients tended to report more severe symptoms, with significantly lower QOL scores and more severe fatigue, poor appetite, and lower enjoyment of life compared with controls (all p < 0.05). In RRMM patients, lower hemoglobin and higher B-2 microglobulin levels significantly correlated with higher burdens of fatigue, pain, and muscle weakness and also with lower QOL and EQ-5D scores (all p < 0.05). During RRMM therapy, being female, with any comorbidity, ≥ 65 years old, and ≥ 5 years MM history, contributed to high symptoms burden and poor QOL status (each p < 0.05).

Conclusions: MDASI-MM modules were sensitive to detect the RRMM-related symptoms burden, which correlated with objective clinical measures. RRMM patients reported a more compromised QOL.

Keywords: Functional outcomes; Multiple myeloma; Patient-reported outcomes; Quality of life; Refractory; Symptom burden.

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References

    1. Siegel DS, Dimopoulos MA, Ludwig H, Facon T, Goldschmidt H, Jakubowiak A, San-Miguel J, Obreja M, Blaedel J, Stewart AK (2018) Improvement in overall survival with carfilzomib, lenalidomide, and dexamethasone in patients with relapsed or refractory multiple myeloma. J Clin Oncol 36(8):728–734. https://doi.org/10.1200/jco.2017.76.5032 - DOI - PubMed
    1. Brenner H, Gondos A, Pulte D (2008) Recent major improvement in long-term survival of younger patients with multiple myeloma. Blood 111(5):2521–2526. https://doi.org/10.1182/blood-2007-08-104984 - DOI - PubMed
    1. Song X, Cong Z, Wilson K (2016) Real-world treatment patterns, comorbidities, and disease-related complications in patients with multiple myeloma in the United States. Curr Med Res Opin 32(1):95–103. https://doi.org/10.1185/03007995.2015.1105202 - DOI - PubMed
    1. Boland E, Eiser C, Ezaydi Y, Greenfield DM, Ahmedzai SH, Snowden JA (2013) Living with advanced but stable multiple myeloma: a study of the symptom burden and cumulative effects of disease and intensive (hematopoietic stem cell transplant-based) treatment on health-related quality of life. J Pain Symptom Manag 46(5):671–680. https://doi.org/10.1016/j.jpainsymman.2012.11.003 - DOI
    1. NCCN (2019) Clinical practice guidelines-multiple myeloma. https://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf . Accessed 10 Oct 2019

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