Patient-Reported Outcomes With Salvage Autologous Stem Cell Transplantation vs Nontransplantation in Relapsed Multiple Myeloma
In an analysis of the phase III UK Myeloma X trial reported in the Journal of Clinical Oncology, Ahmedzai et al found that patient-reported outcomes tended to be worse with salvage autologous stem cell transplantation (ASCT) vs nontransplantation consolidation in relapsed multiple myeloma. The trial, reported several years ago, showed that salvage ASCT was associated with improved time to progression, progression-free survival, and overall survival.
Study Details
The trial enrolled patients between April 2008 and November 2012. The current analysis included 88 of 89 randomly assigned patients in the salvage ASCT group and 83 of 85 in the nontransplantation consolidation group who consented to the quality-of-life substudy.
Pain and quality of life were assessed using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and myeloma-specific module (QLQ-MY20), Brief Pain Inventory (Short Form), and Leeds Assessment of Neuropathic Symptoms and Signs (self-assessment) scale.
Quality-of-Life Outcomes
The median follow-up was 52 months. The EORTC QLQ-C30 global health status scores were higher (better) in the nontransplantation consolidation group at 100 days after random assignment (P = .0496), but not at later time points; the deterioration in global health status in the salvage ASCT group vs the nontransplantation consolidation group was reduced to increasingly smaller differences at 6 months and 1 year, with a slight difference favoring salvage ASCT observed at 2 years.
There was no significant difference in pain interference between groups at 100 days, but scores were higher (worse) in the salvage ASCT group vs the nontransplantation consolidation group at 6 months (P = .0267), with similar significant differences observed for up to 2 years. For all time points considered, pain interference was approximately 1 point lower in the nontransplantation consolidation group, which was considered a clinically relevant difference.
Patients who reported a lower than median score on the side effects of treatment subscale at randomization and who received salvage ASCT had a time to progression advantage over those receiving nontransplantation consolidation (hazard ratio = 0.24, P = .003). Pain scores were not strongly predictive of outcome.
The investigators concluded, “Patients with salvage ASCT with relapsed [multiple myeloma] demonstrated a comparative reduction in quality of life and greater impact of treatment adverse effects lasting for 6 months and up to 2 years for pain, after which patients who had received salvage ASCT reported better outcomes. Patients who experienced lower adverse effects after salvage ASCT 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 quality of life before and after salvage ASCT in patients with relapsed multiple myeloma.”
Gordon Cook, MD, PhD, of the University of Leeds, St. James’s University Hospital, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by Cancer Research UK, Janssen-Cilag, and Chugai Pharma UK. For full disclosures of the study authors, visit jco.ascopubs.org.
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