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J Clin Oncol. 2019 Apr 10:JCO1801006. doi: 10.1200/JCO.18.01006. [Epub ahead of print]

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

Author information

1
1 The University of Sheffield, Sheffield, United Kingdom.
2
2 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
3
3 Pinderfields Hospital, Mid-Yorks NHS Trust, Wakefield, United Kingdom.
4
4 University of Leeds, Leeds, United Kingdom.
5
5 Nottingham City Hospitals, Nottingham City, United Kingdom.
6
6 Barts Health NHS Trust and The London NHS Trust, London, United Kingdom.
7
7 Ipswich Hospital NHS Trust, Ipswich, United Kingdom.
8
8 Manchester Royal Infirmary, Manchester, United Kingdom.
9
9 Royal Derby Hospital, Derby, United Kingdom.
10
10 Medway Maritime Hospital, Gillingham, United Kingdom.
11
11 University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
12
12 University College Hospital, London, United Kingdom.
13
13 The Christie NHS Foundation Trust, Manchester, United Kingdom.
14
14 Plymouth Hospitals Trust, Plymouth, United Kingdom.
15
15 University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
16
16 University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
17
17 Queen's University, Belfast, United Kingdom.

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.

PMID:
30969846
DOI:
10.1200/JCO.18.01006
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