**14. QoL assessment of elderly MM patients**

ASCT or tandem ASCT [25], special issues of the elderly [26], the effect of anemia and fatigue and also the effect of personality on disease outcome [27]. Methodological aspects

Patients with MM experience a very high symptom burden and low HRQOL. In a study published in 2012, the Eindhoven Cancer Registry was used to select all patients diag‐ nosed with MM from 1999 to 2010. Patients were asked at baseline and 1 year later. Patients with MM reported statistically significant and clinically relevant worse scores on all EORTC QLQ-C30 scales compared to the norm. Also, patients with MM reported a mean de‐ crease (e.g., worsening) between baseline and 1-year follow-up scores for: QoL (74% of patients had a deteriorated score), fatigue (50%), nausea and vomiting (71%), pain (59%) and dyspnoea (66%). The most bothering symptoms during the past week were tingling hands/feet (32%), back pain (28%), bone aches/pain (26%), pain in arm/shoulder (19%) and feeling drowsy (18%). Also, 37% worried about their future health, 34% thought about their

**12. QoL differences in transplant-ineligible myeloma patients treated with**

The phase 3 VISTA study (ClinicalTrials.gov NCT00111319) in transplant-ineligible myeloma patients demonstrated superior efficacy with bortezomib-melphalan-prednisone (VMP; nine 6-wk cycles) vs. melphalan-prednisone (MP) but also increased toxicity. HRQoL was evaluated using the EORTC-QLQ-C30 questionnaire. Results demonstrated clinically meaningful, transitory HRQoL decrements with VMP and relatively lower HRQoL vs. MP during early treatment cycles, associated with the expected additional toxicities. However, HRQoL is not compromised in the long term, recovering by the end-of-treatment visit to be comparable vs. MP. Analyses by bortezomib dose intensity indicated better HRQoL in patients receiving lower

**13. HRQoL assessment in MM patients undergoing autologous stem cell**

HRQoL assessment in this patient setting is important as patients and even clinicians are reluctant to choose this modality for fear of declination of QoL. However, it is not the best choice for every patient. HRQoL studies may contribute to the appropriate patient selection. In a population-based study, the Nordic Myeloma Study Group found a survival advantage for high-dose therapy and ASCT compared to conventional chemotherapy in MM patients

**11. Disease-specific complaints and HRQoL of MM patients**

are also emphasized [20].

282 Multiple Myeloma - A Quick Reflection on the Fast Progress

disease and 21% worried about dying [28].

**different drug combinations**

dose intensity [29].

**transplantation**

Thalidomide with melphalan and prednisone (MPT) was defined as standard treatment in elderly patients with MM. In a randomized trial (HOVON49), a prospective HRQoL study was initiated in order to assess the impact of thalidomide on QoL. Patients aged 65 years and older with newly diagnosed MM were randomized to receive melphalan plus prednisone (MP) or MPT, followed by thalidomide maintenance in the MPT arm. 284 patients were included (MP, n=149; MPT n=135). HRQoL was assessed with the QLQ-

C30 and the myeloma-specific module (QLQ-MY24) at baseline and at predetermined intervals during treatment. The QLQ-C30 subscales physical function and constipation showed an improvement during induction in favour of the MP arm. During thalidomide maintenance, the scores for the QLQ-MY24 paraesthesia became significantly higher in the MPT arm. The QLQ-C30 subscales pain, insomnia and appetite loss and the QLQ-MY24 item sick scored marginally better during thalidomide maintenance. The overall QoLscale QLQ-C30-HRQoL showed a significant time trend towards more favorable mean values during protocol treatment without differences between MP and MPT. For the QLQ-C30 subscales emotional function and future perspectives, difference in favour of the MPT arm from the start of treatment was observed with no significant 'time × arm' interac‐ tion, indicating a persistent better patient perspective with MPT treatment. The study concluded that the higher frequency of toxicity associated with MPT does not translate into a negative effect on HRQoL and that MPT holds a better patient perspective [33].

**16. Conclusion**

health policy.

**Abbreviations**

**Author details**

Klára Gadó\*

Hungary

**References**

2893-917.

priate treatment for our patients.

and Gyula Domján

\*Address all correspondence to: gadok@freemail.hu

myeloma. Lancet. (2009). , 374(9686), 324-39.

and amyloidosis. Eur J Cancer. (2006). , 42, 1671-83.

Investigation of QoL has become increasingly important in economically developed countries. HRQoL assessment is becoming a current and integral part of clinical studies with new drugs. Measuring of QoL is becoming more and more important for decision making in the field of

Quality of Life Issues of Patients with Multiple Myeloma

http://dx.doi.org/10.5772/55625

285

MM is a currently incurable disease, but survival can be significantly prolonged by the administration of new therapeutic modalities. The mean age at the time of diagnosis is over 60, so it is especially important to choose the least harmful treatment for the patient so the best quality of life can be achieved. Results of QoL examinations can help us find the most appro‐

**ASCT:** autologous stem cell transplantation; **EORTC:** European Organization for Research and Treatment of Cancer; **HRQoL:** health-related quality of life; **Ig:** immunoglobulin; **MM:**

Semmelweis University, Faculty of Medicine, 1st Department of Internal Medicine, Budapest,

[1] Ferlay, J, Shin, H. R, Bray, F, Forman, D, Mathers, C, & Parkin, D. M. Estimates of worldwide burden of cancer in (2008). GLOBOCAN 2008. Int J Cancer. 2010;, 127,

[2] Raab, M. S, Podar, K, Breitkreutz, I, Richardson, P. G, & Anderson, K. C. Multiple

[3] Sirohi, B, & Powles, R. Epidemiology and outcomes research for MGUS, myeloma

multiple myeloma; **QoL:** quality of life; **WHO:** World Health Organization

Quality-of-life assessment may be an independent and valuable addition to the known prognostic factors in multiple myeloma. In a randomized trial (NMSG 4/90), patients treated with melphalan/prednisone were compared to a melphalan/prednisone + interfer‐ on alpha-2b treated patient group in 486 newly diagnosed multiple myeloma. Univariate analysis showed a highly significant association with survival from the start of therapy for physical functioning as well as role and cognitive functioning, global quality of life, fatigue and pain. In multivariate analysis, physical functioning and W.H.O. performance status were independent prognostic factors when analysed in a Cox regression model with the somatic variables beta-2 microglobulin, skeletal disease and age. The best prediction for survival from the start of therapy was obtained by combining the beta-2 microglobulin and physical functioning scores in a variable consisting of three risk factor levels with an estimated median survival of 17, 29 and 49 months, respectively [34].
