**8. Myeloma-specific HRQoL aspects**

MM is a chronic, incurable disease that is associated with reduced quality of life. MM patients have to face the problems of living with a chronic illness longer as a result of prolonged survival. However, they are also faced with the difficulties related to a malignant disease. Disease symptoms, concerns with certain therapeutic modalities and also the QoL changes due to organ transplantation emerge. Generation of pathologic bone fracture, bone pain, fatigue because of anemia and malignant disease itself, neurological symptoms due to hypercalcaemia have a profound impact on the QoL of MM patients.

Chronic renal failure develops in one third of MM patients. Chronic dialysis treatment implicates several life style changes.

Most anti-myeloma therapies involve intravenous injections or infusions. Regular laboratory check-ups require repeated blood sample collections that require multiple encounters with needles. Taking bone marrow for diagnosis and several times afterward for control examina‐ tions is very painful unless it is performed in narcosis.

ASCT has considerable effects on QoL. High-dose chemotherapy presents significant side effects and subsequently a reduction of QoL. This is due mainly to infections, mucositis, increased use of blood products and prolonged stays in the hospital.

Side-effects of several lines of treatments include polyneuropathy, deep vein thrombosis, loss of hair and constipation. Osteonecrosis of the jaw caused by bisphosphonates, though a rare event, results in severe deterioration of QoL.

Recurrent infections due to the patients' immunocompromised status, the disease itself and also due to the several lines of treatment used to control the disease also contribute to the worsening of QoL.
