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Thoren K, Menad S, Nouadje G, Macé S. Isatuximab-Specific Immunofixation Electrophoresis Assay to Remove Interference in Serum M-Protein Measurement in Patients with Multiple Myeloma. J Appl Lab Med 2024:jfae028. [PMID: 38573925 DOI: 10.1093/jalm/jfae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/26/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Isatuximab, an IgG-kappa (IgGκ) anti-cluster of differentiation 38 (CD38) monoclonal antibody approved for use in patients with relapsed or refractory multiple myeloma (MM), can potentially interfere with the visualization of endogenous monoclonal protein (M-protein) on standard immunofixation electrophoresis (IFE) and lead to inaccurate classification of a patient's response to therapy. The Hydrashift 2/4 isatuximab IFE assay (Hydrashift isatuximab assay) removes isatuximab interference from IFE. Using samples from patients enrolled in clinical trials of isatuximab-based therapy for MM, we demonstrate how the Hydrashift isatuximab assay improves the ability to detect residual M-protein and offer recommendations for when the assay is most useful. METHODS Samples from 141 patients with a variety of known M-protein isotypes were selected and analyzed by standard IFE and the Hydrashift isatuximab assay. A positive control containing isatuximab was run on every standard IFE and Hydrashift gel. RESULTS The Hydrashift isatuximab assay reliably shifted the migration of isatuximab in patient samples. Standard IFE was adequate for determining 104 patients' M-protein status, and the Hydrashift isatuximab assay confirmed these results. In samples from 37 patients with a history of IgGκ MM and a single IgGκ band visible on standard IFE near the isatuximab migration site, the Hydrashift isatuximab assay was able to separate isatuximab from endogenous M-protein, identifying residual M-protein in 17 samples and preventing false-positive interpretations of standard IFE in 20 samples. CONCLUSIONS The Hydrashift isatuximab assay is most useful in patients with known IgGκ MM when a single IgGκ band appears near the isatuximab migration site on standard IFE during isatuximab-based therapy. ClinicalTrials.gov Registration Numbers: NCT03275285 and NCT03319667.
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Affiliation(s)
- Katie Thoren
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
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Chen R, Yang J, Mao Y, Zhao X, Cheng R, Deng C, Zhong Z. Antibody-Mediated Nanodrug of Proteasome Inhibitor Carfilzomib Boosts the Treatment of Multiple Myeloma. Biomacromolecules 2023; 24:5371-5380. [PMID: 37801632 DOI: 10.1021/acs.biomac.3c00830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Multiple myeloma (MM) is the second most common hematological malignancy. For relapsed and refractory MM, a proteasome inhibitor, carfilzomib (CFZ), has become one of the few clinical options. CFZ suffers, nevertheless, metabolic instability and poor bioavailability and may induce severe cardiovascular and renal adverse events. Here, we report that daratumumab (Dar)-decorated polypeptide micelles (Dar-PMs) mediate the targeted delivery of CFZ to CD38-positive MM, effectively boosting its anti-MM efficacy. CFZ-loaded Dar-PMs (Dar-PMs-CFZ) exhibited an average diameter of ca. 80 nm and Dar density-dependent cell endocytosis and anti-MM activity, in which over 6-fold greater inhibitory effect to LP-1 and MM.1S MM cells than nontargeted PMs-CFZ control was achieved at a Dar density of 3.2 (Dar3.2-PMs-CFZ). Interestingly, Dar3.2-PMs-CFZ markedly enhanced the growth inhibition of orthotopic LP-1 MM in mice and significantly extended the median survival time compared with PMs-CFZ and free CFZ (95 days vs 60 and 54 days, respectively). In line with its high MM targetability and anti-MM efficacy, Dar3.2-PMs-CFZ revealed little toxic effects and effectively prevented osteolytic lesions. The antibody-targeted nanodelivery of a proteasome inhibitor appears to be an appealing strategy to treat multiple myeloma.
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Affiliation(s)
- Ran Chen
- Biomedical Polymers Laboratory, and Jiangsu Key Laboratory of Advanced Functional Polymer Design and Application, College of Chemistry, Chemical Engineering and Materials Science, and State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou 215123, China
| | - Jiakun Yang
- Biomedical Polymers Laboratory, and Jiangsu Key Laboratory of Advanced Functional Polymer Design and Application, College of Chemistry, Chemical Engineering and Materials Science, and State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou 215123, China
| | - Yumin Mao
- Biomedical Polymers Laboratory, and Jiangsu Key Laboratory of Advanced Functional Polymer Design and Application, College of Chemistry, Chemical Engineering and Materials Science, and State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou 215123, China
| | - Xiaofei Zhao
- Biomedical Polymers Laboratory, and Jiangsu Key Laboratory of Advanced Functional Polymer Design and Application, College of Chemistry, Chemical Engineering and Materials Science, and State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou 215123, China
| | - Ru Cheng
- Biomedical Polymers Laboratory, and Jiangsu Key Laboratory of Advanced Functional Polymer Design and Application, College of Chemistry, Chemical Engineering and Materials Science, and State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou 215123, China
| | - Chao Deng
- Biomedical Polymers Laboratory, and Jiangsu Key Laboratory of Advanced Functional Polymer Design and Application, College of Chemistry, Chemical Engineering and Materials Science, and State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou 215123, China
| | - Zhiyuan Zhong
- Biomedical Polymers Laboratory, and Jiangsu Key Laboratory of Advanced Functional Polymer Design and Application, College of Chemistry, Chemical Engineering and Materials Science, and State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou 215123, China
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Dachs LR, Gaisán CM, Bustamante G, López SG, García EG, Persona EP, González-Calle V, Auzmendi MS, Pérez JMA, González Montes Y, Ríos Tamayo R, de Miguel Llorente D, Bernal LP, Mayol AS, Caro CC, Grande M, Fernández-Nistal A, Naves A, Miguel EMOS. Assessment of the psychometric properties of the Spanish version of EORTC QLQ-MY20 and evaluation of health-related quality of Life outcomes in patients with relapsed and/or refractory multiple myeloma in the real-world setting in Spain: results from the CharisMMa study. Leuk Lymphoma 2023; 64:1847-1856. [PMID: 37539698 DOI: 10.1080/10428194.2023.2240922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023]
Abstract
We evaluated the psychometric properties of the Spanish version of the European Organization for Research and Treatment of Multiple Myeloma (MM) specific quality-of-life (QoL) questionnaire module (QLQ-MY20) in relapsed/refractory MM (RRMM) patients. This was an observational, cross-sectional, multicenter study using EORTC QLQ-C30 and QLQ-MY20 in RRMM patients (ClinicalTrials.gov ID NCT03188536). We assessed the non-response rate, ceiling/floor effects, internal consistency, test-retest reliability, and validity. The study included 276 patients (53.3% males, mean [SD] age of 67.4 [10.5] years). The EORTC QLQ-MY20 showed a low non-response rate, very low ceiling and floor effects, and good internal consistency. The test-retest reliability assessment revealed good temporary stability, the construct validity analysis stated four main factors similar to the ones of the original version, and the criterion validity assessment showed no differences between groups. In conclusion, the Spanish version of EORTC QLQ-MY20 is a reliable and valid tool for assessing QoL in RRMM patients.
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Affiliation(s)
| | - Carmen Montes Gaisán
- Hospital Universitario Marqués de Valdecilla (IDIVAL). Universidad de Cantabria. Santander, Spain
| | | | | | | | - Ernesto Pérez Persona
- Instituto de Investigación Sanitaria Bioaraba, Vitoria-Gasteiz, Spain
- Osakidetza. Hospital Universitario de Álava. Vitoria-Gasteiz, Spain
| | - Verónica González-Calle
- Hospital Universitario de Salamanca (HUS/IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red (CIBERONC), Spain
- Instituto Universitario de Biología Molecular y Celular del Cáncer - IBMCC (USAL-CSIC), Salamanca, Spain
| | | | | | | | | | | | | | | | | | - Marta Grande
- Takeda Farmacéutica España, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
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Boquoi A, Giagounidis A, Goldschmidt H, Heinsch M, Rummel MJ, Kröger N, Mai EK, Strapatsas J, Haas R, Kobbe G. Health-Related Quality of Life in Multiple Myeloma Patients Treated with High- or Low-Dose Lenalidomide Maintenance Therapy after Autologous Stem Cell Transplantation-Results from the LenaMain Trial (NCT00891384). Cancers (Basel) 2023; 15:5157. [PMID: 37958331 PMCID: PMC10650513 DOI: 10.3390/cancers15215157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/02/2023] [Accepted: 09/25/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION The LenaMain trial (NCT00891384) reported increased progression-free survival with 25 mg of lenalidomide maintenance compared to 5 mg. Here, we report the patient-reported outcomes. MATERIALS AND METHODS Scores obtained from the EORTC Quality of Life Questionnaire C30 were analyzed for longitudinal changes from baseline within the groups as well as cross-sectional scores. RESULTS Compliance rates were high, with 95.7% at baseline and 70% during maintenance. At study entry, scores were high for functioning and low for symptoms. During maintenance, the median global health status/quality of life (GHS/QoL) was constant, without significant differences over time (median GHS/QoL: 68 at baseline and 58 for Len high and 68 for Len low at 2 years) and between treatment arms (mean change < 2). Similarly, most functional scale domains were constant. Notably, diarrhea increased consistently for both treatment arms (baseline: -1.905 (range: -5.78-1.97); end of year 2: 16.071 (range: 5.72-26.42); p < 0.05). The subgroup analysis showed that neither disease activity, duration of treatment, nor adverse events affected the health-related quality of life (HR-QoL) or utility. CONCLUSION High baseline scores were maintained throughout the trial without significant differences between the Len dosages, which supports continuous treatment with a dose tailored to patients' HR-QoL.
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Affiliation(s)
- Amelie Boquoi
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, 40225 Duesseldorf, Germany; (J.S.); (R.H.); (G.K.)
| | - Aristoteles Giagounidis
- Klinik für Onkologie, Hämatologie und Palliativmedizin, Marien Hospital Düsseldorf, Rochusstr. 2, 40479 Düsseldorf, Germany;
| | - Hartmut Goldschmidt
- National Center for Tumor Diseases Heidelberg (NCT), 69120 Heidelberg, Germany;
- Department of Internal Medicine V, University of Heidelberg, 69120 Heidelberg, Germany
| | | | - Mathias J. Rummel
- Medizinische Klinik IV, University Hospital, 35392 Giessen, Germany;
| | | | - Elias K. Mai
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, 69120 Heidelberg, Germany;
| | - Judith Strapatsas
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, 40225 Duesseldorf, Germany; (J.S.); (R.H.); (G.K.)
| | - Rainer Haas
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, 40225 Duesseldorf, Germany; (J.S.); (R.H.); (G.K.)
| | - Guido Kobbe
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, 40225 Duesseldorf, Germany; (J.S.); (R.H.); (G.K.)
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Blue B, Pierre A, Mikhael J. Culturally Responsive Care Delivery in Oncology: The Example of Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:651-659. [PMID: 37290997 DOI: 10.1016/j.clml.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 06/10/2023]
Abstract
Multiple myeloma (MM) represents ∼1% of all cancers and is the second most common hematologic malignancy worldwide. The incidence of MM is at least two times higher in Blacks/African Americans compared with their White counterparts, and Hispanics/Latinxs are among the youngest patients diagnosed with the disease. Recent advances in available treatments for MM have demonstrated significant improvement in survival outcomes; however, patients from non-White racial/ethnic groups clinically benefit less due to multiple factors including access to care, socioeconomic status, medical mistrust, underutilization of novel therapies, and exclusion from clinical trials. Health inequities in disease characteristics and risk factors based on race also contribute to inequities in outcomes. In this review, we highlight racial/ethnic factors as well as structural barriers attributed to variations in MM epidemiology and management. We focus on three populations-Black/African American, Hispanic/Latinx, and American Indian/Alaska Native-and review factors that healthcare professionals may consider when treating patients of color. We offer tangible advice for healthcare professionals on how to incorporate cultural humility into their practice by following the five key steps: establishing trust, respecting cultural diversity, undergoing cross-cultural training, counseling patients on appropriate available clinical trial options, and connecting patients to community resources. The outlined recommendations will help the medical community to better understand and apply the important concept of cultural humility into their practice to provide the best care for all their patients, regardless of race/ethnicity.
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Affiliation(s)
- Brandon Blue
- H. Lee Moffitt Cancer Center and Research Institute, Department of Malignant Hematology, Tampa, FL.
| | - Amy Pierre
- Memorial Sloan Kettering Cancer Center, Division of Multiple Myeloma and Lymphoma, Montvale, NJ; Flatiron Health, Division of Research Oncology and Real World Evidence, New York, NY
| | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ; International Myeloma Foundation, Chief Medical Officer, Studio City, CA
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Popat R, Lonial S, Voorhees PM, Esposti SD, Gorsh B, Gupta I, Opalinska J, Sapra S, Piontek T, He Z, Kleinman D, Schaumberg D, Regnault A, Meunier J, Eliason L. Patient-Reported Outcomes With Belantamab Mafodotin Treatment in Patients With Triple-Class Refractory Multiple Myeloma. J Adv Pract Oncol 2023; 14:503-518. [PMID: 37808071 PMCID: PMC10558016 DOI: 10.6004/jadpro.2023.14.6.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
In the randomized phase II DREAMM-2 study, single-agent belantamab mafodotin demonstrated deep and durable responses and a manageable safety profile in triple-class refractory relapsed/refractory multiple myeloma (RRMM). We present patient-reported outcomes (PROs) from this study for patients treated with the approved dose of belantamab mafodotin (2.5 mg/kg q3w). Disease and treatment-related symptoms, health-related quality of life (HRQOL), functioning, and patient-reported ocular changes were assessed using questionnaires (European Organisation for Research and Treatment of Cancer Quality of Life questionnaires EORTC-QLQ-C30 and EORTC-QLQ-MY20, Ocular Surface Disease Index [OSDI], and the National Eye Institute Visual Functioning Questionnaire 25 [NEI VFQ-25]) at baseline, during treatment (every 3 or 6 weeks), and at the end of treatment (EOT). Eye examinations were conducted at baseline, prior to each treatment cycle, and at EOT. Patients reported ocular symptoms in the OSDI and NEI VFQ-25 questionnaires, with the median time to worst severity of 45 to 64 days depending on symptoms considered. Some limitations in driving and reading were reported. Ocular symptoms were improved and median time to recovery was 23.5 to 44.0 days. EORTC-QLQ-C30 data suggest core MM symptoms (including fatigue and pain), overall HRQOL, and patient functioning were maintained while patients continued belantamab mafodotin treatment, even if meaningful worsening of vision-related symptoms occurred. These PRO results, together with the clinical efficacy of belantamab mafodotin, support its use in patients with RRMM and further evaluation of its use at earlier lines of therapy.
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Affiliation(s)
- Rakesh Popat
- From NIHR University College London Hospitals Clinical Research Facility, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sagar Lonial
- Emory University, Winship Cancer Institute, Atlanta, Georgia, USA
| | - Peter M. Voorhees
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Simona Degli Esposti
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | | | - Ira Gupta
- GSK, Upper Providence, Pennsylvania, USA
| | | | | | | | | | - David Kleinman
- Flaum Eye Institute, University of Rochester, Rochester, New York, USA
| | - Debra Schaumberg
- University of Utah School of Medicine, Department of Ophthalmology & Visual Sciences, Salt Lake City, Utah, USA
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Fonseca R, Tran D, Laidlaw A, Rosta E, Rai M, Duran J, Ammann EM. Impact of Disease Progression, Line of Therapy, and Response on Health-Related Quality of Life in Multiple Myeloma: A Systematic Literature Review. CLINICAL LYMPHOMA MYELOMA AND LEUKEMIA 2023; 23:426-437.e11. [PMID: 37061416 DOI: 10.1016/j.clml.2023.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
This systematic literature review (SLR) was conducted to better understand the impact of disease progression, line of therapy, and clinical response on health-related quality of life (HRQoL) in patients with multiple myeloma (MM). Multiple databases were searched to identify records relating to HRQoL in adult patients with MM. Titles and abstracts were independently screened by 2 reviewers for inclusion based on pre-defined criteria. Records flagged for inclusion had full texts subsequently screened using the same method. A third round of screening was then conducted to identify studies that assessed the relationship of HRQoL to disease progression, line of therapy, or clinical response. Quality assessment was conducted on utility studies using the National Institute for Health and Care Excellence Quality Assessment Checklist for Health State Utility Values. After all rounds of screening were complete, 44 records (representing 41 studies) were included in the SLR. Thirty records reported data relating HRQoL to disease progression, 5 reported data relating HRQoL to line of therapy, and 19 reported data relating HRQoL to response. Despite a lack of homogeneity and small number of studies, the data show overall that progressive disease and increasing lines of therapy were associated with worsened patient HRQoL and increasing depth of response was associated with improved patient HRQoL. The findings from this SLR support that desirable treatment outcomes such as delayed progression, fewer lines of therapy, and achieving the deepest possible clinical response result in improved HRQoL in patients with MM.
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Affiliation(s)
| | - Diana Tran
- EVERSANA(TM), Burlington, Ontario, Canada
| | | | | | - Manvir Rai
- EVERSANA(TM), Burlington, Ontario, Canada
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D’Souza A, Brazauskas R, Stadtmauer EA, Pasquini MC, Hari P, Bashey A, Callander N, Devine S, Efebera Y, Ganguly S, Gasparetto C, Geller N, Horowitz MM, Koreth J, Landau H, Brunstein C, McCarthy P, Qazilbash MH, Giralt S, Krishnan A, Flynn KE. Trajectories of quality of life recovery and symptom burden after autologous hematopoietic cell transplantation in multiple myeloma. Am J Hematol 2023; 98:140-147. [PMID: 35567778 PMCID: PMC9659666 DOI: 10.1002/ajh.26596] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/11/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023]
Abstract
Early autologous hematopoietic cell transplantation (AHCT) with post-transplant maintenance therapy is standard of care in multiple myeloma (MM). While short-term quality of life (QOL) deterioration after AHCT is known, the long-term trajectories and symptom burden after transplantation are largely unknown. Toward this goal, a secondary analysis of QOL data of the BMT CTN 0702, a randomized controlled trial comparing outcomes of three treatment interventions after a single AHCT (N = 758), was conducted. FACT-BMT scores up to 4 years post-AHCT were analyzed. Symptom burden was studied using responses to 17 individual symptoms dichotomized as 'none/mild' for scores 0-2 and 'moderate/severe' for scores of 3 or 4. Patients with no moderate/severe symptom ratings were considered to have low symptom burden at 1-year. Mean age at enrollment was 55.5 years with 17% African Americans. Median follow-up was 6 years (range, 0.4-8.5 years). FACT-BMT scores improved between enrollment and 1-year and remained stable thereafter. Low symptom burden was reported by 27% of patients at baseline, 38% at 1-year, and 32% at 4 years post-AHCT. Predictors of low symptom burden at 1-year included low symptom burden at baseline: OR 2.7 (1.8-4.1), p < 0.0001; older age: OR 2.1 (1.3-3.2), p = 0.0007; and was related to being employed: OR 2.1 (1.4-3.2), p = 0.0004). We conclude that MM survivors who achieve disease control after AHCT have excellent recovery of FACT-BMT and subscale scores to population norms by 1-year post-transplant, though many patients continue to report moderate to severe severity in some symptoms at 1-year and beyond.
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Affiliation(s)
- Anita D’Souza
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ruta Brazauskas
- Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Edward A. Stadtmauer
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marcelo C. Pasquini
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Parameswaran Hari
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Asad Bashey
- Department of Hematology/Oncology, BMT Group of Georgia, Atlanta, Georgia, USA
| | - Natalie Callander
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Steven Devine
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Yvonne Efebera
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Siddhartha Ganguly
- Department of Medicine, Kansas University Medical Center, Kansas City, Kansas, USA
| | | | - Nancy Geller
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Mary M. Horowitz
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - John Koreth
- Department of Medicine, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Heather Landau
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Claudio Brunstein
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Philip McCarthy
- Department of Medicine, Roswell Park Cancer Center, Buffalo, New York, USA
| | - Muzaffar H. Qazilbash
- Department of Stem Cell Transplantation, MD Anderson Cancer Center, Houston, Texas, USA
| | - Sergio Giralt
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Amrita Krishnan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Cancer Center, Duarte, California, USA
| | - Kathryn E. Flynn
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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9
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Martin T, Lin Y, Agha M, Cohen AD, Htut M, Stewart AK, Hari P, Berdeja JG, Usmani SZ, Yeh TM, Olyslager Y, Goldberg JD, Schecter JM, Madduri D, Jackson CC, Deraedt W, Gries KS, Fastenau JM, Trudeau JJ, Akram M, Pacaud L, Jakubowiak A, Jagannath S. Health-related quality of life in patients given ciltacabtagene autoleucel for relapsed or refractory multiple myeloma (CARTITUDE-1): a phase 1b–2, open-label study. THE LANCET HAEMATOLOGY 2022; 9:e897-e905. [DOI: 10.1016/s2352-3026(22)00284-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022]
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Fischer J, Knop S, Danhof S, Einsele H, Keller D, Löffler C. The influence of baseline characteristics, treatment and depression on health-related quality of life in patients with multiple myeloma: a prospective observational study. BMC Cancer 2022; 22:1032. [PMID: 36192719 PMCID: PMC9528097 DOI: 10.1186/s12885-022-10101-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 09/13/2022] [Indexed: 12/09/2022] Open
Abstract
Background Multiple myeloma (MM) is the third most common hematologic malignancy with increasing importance due to improving treatment strategies and long-term outcomes in an aging population. This study aims to analyse influencing factors on health-related quality of life (HRQoL), such as treatment strategies, participation in a clinical trial and patient characteristics like anxiety, depression, gender, and age. A better understanding of the individual factors in context with HRQoL could provide a helpful instrument for clinical decisions. Methods In this prospective observational study, the HRQoL of MM patients with different therapies (first-line and relapse) was quantified by standardized questionnaires (EORTC QLQ-C30 and -MY20) in the context of sociodemographic data, individual anxiety and depressiveness (PHQ-4), and a selected number of clinical parameters and symptoms at defined time-points before, during, and after therapy. Results In total, 70 patients were included in the study. The median age of the study cohort was 62 years. 44% were female and 56% were male patients. More than half of the patients were fully active with an ECOG 0. Global health status was significantly higher in patients with first-line treatment and even increased after start of therapy, while the pain level decreased. In contrast, patients with relapsed MM reported a decreasing global health status and increasing pain. Additionally, there was a higher global health status in less anxious/depressive patients. HRQoL decreased significantly after start of chemotherapy in the parameters body image, side effects of treatment, and cognitive functioning. Tandem stem-cell transplantation was not found to be a risk factor for higher impairment of HRQoL. Participation in a clinical study led to an improvement of most aspects of HRQoL. Among others, increased anxiety and depression, female gender, older age, impaired performance status, and recurrent disease can be early indicators for a reduced HRQoL. Conclusion This study showed the importance of regular longitudinal assessments of patient reported outcomes (PROs) in routine clinical care. For the first time, to our knowledge, we were able to demonstrate a potential impact between participation in clinical trials and HRQoL. However, due to frequently restrictive inclusion criteria for clinical trials, these MM patients might not be directly comparable with patients treated within standard therapy concepts. Further studies are needed to clarify the relevance of this preliminary data in order to develop an individualized, patient-centred, therapy concept. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-10101-9.
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Affiliation(s)
- Julia Fischer
- Department of Pediatrics, Wuerzburg University Medical Center, Josef-Schneider-Straße 2, 97080, Würzburg, Germany.
| | - Stefan Knop
- Department of Haematology and Oncology, Wuerzburg University Medical Center, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Sophia Danhof
- Department of Haematology and Oncology, Wuerzburg University Medical Center, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Hermann Einsele
- Department of Haematology and Oncology, Wuerzburg University Medical Center, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Daniela Keller
- "Daniela Keller - Statistik und Beratung", Prosselsheimer Straße 4, 97273, Kuernach, Germany
| | - Claudia Löffler
- Department of Haematology and Oncology, Wuerzburg University Medical Center, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
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Malta JS, Drummond PLDM, Silveira LP, Costa NL, Santos RMMD, Machado CJ, Reis AMM, de Pádua CAM. Effect of therapeutic regimens and polypharmacy on health-related quality of life of people with multiple myeloma: a cross-sectional study in Belo Horizonte, Brazil. Curr Med Res Opin 2022; 38:1275-1283. [PMID: 35083943 DOI: 10.1080/03007995.2022.2034387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Multiple myeloma (MM) is an incurable hematological cancer and its treatment is geared to promote better Health-Related Quality of Life (HRQoL). We aimed to assess HRQoL and compare scores between variables on therapeutic regimens and polypharmacy in MM patients. METHODS This cross-sectional study was performed from April/2019 to February/2020 in Belo Horizonte, Brazil. HRQoL scores were obtained by the QLQ-C30 and QLQ-MY20 instruments. Data were retrieved from interviews and medical records. Therapeutic regimens were grouped into thalidomide-containing regimens; bortezomib-containing regimens; bortezomib and thalidomide-containing regimens; other therapeutic regimens, and remission group. We performed univariate analyses by the Mann-Whitney method and adopted the Kruskal-Wallis test for multiple comparisons. Robust multiple linear regression was used to determine the association between independent variables and the HRQoL scores. RESULTS The sample included 225 participants and most patients (65.3%) were on active treatment and had worse scores concerning future perspective. Polypharmacy was associated with worse scores on all scales in the univariate analyses. We observed a difference in the global health and body image (p < .05) scales in the multiple comparisons with therapeutic regimens. The global health scale difference was found between groups with other regimens and the remission group (p < .05). The difference between the bortezomib and thalidomide-containing regimens and remission group was not statistically significant (p = .077) in the body image scale. The multiple linear regression maintained the association of polypharmacy with worse HRQoL scores. CONCLUSION We identified an independent association between HRQoL and polypharmacy in MM patients. However, there was no difference between the evaluated regimens, suggesting they are equivalent in Brazil about HRQoL.
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Affiliation(s)
- Jéssica Soares Malta
- Departamento de Farmácia Social, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Brasil
| | - Paula Lana de Miranda Drummond
- Departamento de Farmácia Social, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Brasil
- Fundação Ezequiel Dias - Funed, Belo Horizonte, Brasil
| | - Lívia Pena Silveira
- Departamento de Farmácia Social, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Brasil
- Hospital das Clínicas da UFMG, Belo Horizonte, Brasil
| | - Naiane Lima Costa
- Departamento de Farmácia Social, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Brasil
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12
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Efficace F, Cottone F, Sparano F, Caocci G, Vignetti M, Chakraborty R. Patient-Reported Outcomes in Randomized Controlled Trials of Patients with Multiple Myeloma: A Systematic Literature Review of Studies Published Between 2014 and 2021. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:442-459. [PMID: 35183476 DOI: 10.1016/j.clml.2022.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND We performed a systematic literature review to identify the most recently published randomized controlled trials (RCTs) in multiple myeloma (MM) with a patient-reported outcome (PRO) endpoint, and to summarize both clinical and PRO results, as well as to examine the quality of reporting by phase of disease. We also aimed to describe main type of PRO analysis used and interpretation of clinical significance of PRO findings. MATERIALS AND METHODS We searched PubMed and the Cochrane Central Register of Controlled Trials to identify RCTs of cancer-directed therapy in patients with MM published between January 2014 and April 2021. RESULTS Thirty-two RCTs with a total of 19,798 patients enrolled were identified in our review. In all studies, PROs were secondary or exploratory endpoints. Half of the studies (n = 16) included newly diagnosed patients, 15 RCTs included patients with relapsed/refractory MM, and one study included patients with smoldering MM. Progression-free survival was the most frequently used primary endpoint. All studies provided unique PRO information that could be used to more comprehensively assess the risk/benefit of the newly tested drugs. However, the identified RCTs were heterogeneous regarding the presentation, and interpretation of PRO results. CONCLUSION The number of RCTs including PROs in MM research has notably increased in recent years. However, more consistency in the methodological approach to PRO assessment, and interpretation of outcomes is needed to ensure that PRO findings will be more impactful on patient care.
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Affiliation(s)
- Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy.
| | - Francesco Cottone
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Francesco Sparano
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Giovanni Caocci
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Rajshekhar Chakraborty
- Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
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13
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Terpos E, Dimopoulos MA, Boccadoro M, Delimpasi S, Beksac M, Katodritou E, Moreau P, Pompa A, Symeonidis A, Bila J, Oriol A, Mateos M, Einsele H, Orfanidis I, Gries KS, Fastenau J, Liu K, He J, Kampfenkel T, Qiu Y, Amin H, Carson R, Sonneveld P. Health-related quality of life in patients with relapsed/refractory multiple myeloma treated with pomalidomide and dexamethasone ± subcutaneous daratumumab: Patient-reported outcomes from the APOLLO trial. Am J Hematol 2022; 97:481-490. [PMID: 35089607 DOI: 10.1002/ajh.26480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/06/2022] [Accepted: 01/24/2022] [Indexed: 11/12/2022]
Abstract
In the phase 3 APOLLO trial, daratumumab in combination with pomalidomide and dexamethasone (D-Pd) significantly reduced the rate of disease progression or death by 37% relative to Pd alone in patients with relapsed/refractory multiple myeloma (RRMM) who had received ≥1 prior line of therapy including lenalidomide and a proteasome inhibitor. Here, we present patient-reported outcomes (PROs) from APOLLO. Median treatment duration was 11.5 months with D-Pd and 6.6 months with Pd. PRO compliance rates were high and similar in both groups. No changes from baseline were observed for EORTC QLQ-C30 global health status scores in either group, while physical and emotional functioning, disease symptoms, and adverse effects of treatment remained at baseline levels with D-Pd but worsened with Pd. Reductions (p < 0.05) in pain and fatigue were seen at several time points with D-Pd versus Pd. Overall, these results suggest patients' health-related quality of life remained stable when daratumumab was added to Pd, with several results favoring D-Pd versus Pd. These findings complement the significant clinical improvements observed with D-Pd and support its use in patients with RRMM.
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Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics National and Kapodistrian University of Athens Athens Greece
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics National and Kapodistrian University of Athens Athens Greece
| | - Mario Boccadoro
- Department of Molecular Biotechnology and Health Sciences University of Torino Turin Italy
| | | | - Meral Beksac
- Department of Hematology Ankara University Ankara Turkey
| | - Eirini Katodritou
- Department of Hematology Theagenio Cancer Hospital Thessaloniki Greece
| | - Philippe Moreau
- Hematology Department University Hospital Hôtel‐Dieu Nantes France
| | | | | | - Jelena Bila
- Clinic of Hematology University of Belgrade Belgrade Serbia
| | - Albert Oriol
- Institut Català d'Oncologia Hospital Germans Trias I Pujol Barcelona Spain
| | - Maria‐Victoria Mateos
- Hematology Department University Hospital of Salamanca/IBSAL/Cancer Research Center‐IBMCC (USAL‐CSIC) Salamanca Spain
| | - Hermann Einsele
- Department of Internal Medicine II University Hospital Würzburg Würzburg Germany
| | | | | | - John Fastenau
- Janssen Research & Development LLC Raritan New Jersey USA
| | - Kevin Liu
- Janssen Research & Development LLC Raritan New Jersey USA
| | - Jianming He
- Janssen Research & Development LLC Raritan New Jersey USA
| | | | - Yanping Qiu
- Janssen Research & Development LLC Beijing China
| | - Himal Amin
- Janssen Research & Development LLC Raritan New Jersey USA
| | - Robin Carson
- Janssen Research & Development LLC Wayne Pennsylvania USA
| | - Pieter Sonneveld
- Department of Hematology Erasmus University Medical Center Cancer Institute Rotterdam Netherlands
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14
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Tremblay G, Daniele P, Breeze J, Li L, Shah J, Shacham S, Kauffman M, Engelhardt M, Chari A, Nooka A, Vogl D, Gavriatopoulou M, Dimopoulos MA, Richardson P, Biran N, Siegel D, Vlummens P, Doyen C, Facon T, Mohty M, Meuleman N, Levy M, Costa L, Hoffman JE, Delforge M, Kaminetzky D, Weisel K, Raab M, Dingli D, Tuchman S, Laurent F, Vij R, Schiller G, Moreau P, Richter J, Schreder M, Podar K, Parker T, Cornell RF, Lionel K, Choquet S, Sundar J. Quality of life analyses in patients with multiple myeloma: results from the Selinexor (KPT-330) Treatment of Refractory Myeloma (STORM) phase 2b study. BMC Cancer 2021; 21:993. [PMID: 34488662 PMCID: PMC8419947 DOI: 10.1186/s12885-021-08453-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 06/07/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Selinexor is an oral, selective nuclear export inhibitor. STORM was a phase 2b, single-arm, open-label, multicenter trial of selinexor with low dose dexamethasone in patients with penta-exposed relapsed/refractory multiple myeloma (RRMM) that met its primary endpoint, with overall response of 26% (95% confidence interval [CI], 19 to 35%). Health-related quality of life (HRQoL) was a secondary endpoint measured using the Functional Assessment of Cancer Therapy - Multiple Myeloma (FACT-MM). This study examines impact of selinexor treatment on HRQoL of patients treated in STORM and reports two approaches to calculate minimal clinically important differences for the FACT-MM. METHODS FACT-MM data were collected at baseline, on day 1 of each 4-week treatment cycle, and at end of treatment (EOT). Changes from baseline were analyzed for the FACT-MM total score, FACT-trial outcome index (TOI), FACT-General (FACT-G), and the MM-specific domain using mixed-effects regression models. Two approaches for evaluating minimal clinically important differences were explored: the first defined as 10% of the instrument range, and the second based on estimated mean baseline differences between Eastern Cooperative Oncology Group performance status (ECOG PS) scores. Post-hoc difference analysis compared change in scores from baseline to EOT for treatment responders and non-responders. RESULTS Eighty patients were included in the analysis; the mean number of prior therapies was 7.9 (standard deviation [SD] 3.1), and mean duration of myeloma was 7.6 years (SD 3.4). Each exploratory minimal clinically important difference threshold yielded consistent results whereby most patients did not experience HRQoL decline during the first six cycles of treatment (range: 53.9 to 75.7% for the first approach; range: 52.6 to 72.9% for the second). Treatment responders experienced less decline in HRQoL from baseline to EOT than non-responders, which was significant for the FACT-G, but not for other scores. CONCLUSION The majority of patients did not experience decline in HRQoL based on minimal clinically important differences during early cycles of treatment with selinexor and dexamethasone in the STORM trial. An anchor-based approach utilizing patient-level data (ECOG PS score) to define minimal clinically important differences for the FACT-MM gave consistent results with a distribution-based approach. TRIAL REGISTRATION This trial was registered on ClinicalTrials.gov under the trial-ID NCT02336815 on January 8, 2015.
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Affiliation(s)
- Gabriel Tremblay
- Purple Squirrel Economics, 1600 Notre Dame W, Suite 201, Montreal, QC, H3J 1M1, Canada.
| | - Patrick Daniele
- Purple Squirrel Economics, 1600 Notre Dame W, Suite 201, Montreal, QC, H3J 1M1, Canada
| | - Janis Breeze
- Purple Squirrel Economics, 1600 Notre Dame W, Suite 201, Montreal, QC, H3J 1M1, Canada
| | | | - Jatin Shah
- Karyopharm Therapeutics Inc., Newton, USA
| | | | | | | | - Ajaj Chari
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ajay Nooka
- Winship Cancer Institute, Emory University, Atlanta, USA
| | - Dan Vogl
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | | | | | - Noa Biran
- Hackensack Meridian Health Hackensack University Medical Center, Hackensack, USA
| | - David Siegel
- Hackensack Meridian Health Hackensack University Medical Center, Hackensack, USA
| | | | - Chantal Doyen
- Université catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | | | | | | | - Moshe Levy
- Baylor University Medical Center, Dallas, USA
| | - Luciano Costa
- University of Alabama at Birmingham, Birmingham, USA
| | | | | | | | - Katja Weisel
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Raab
- University of Heidelberg, Heidelberg, Germany
| | | | - Sascha Tuchman
- Lineberger Comprehensive Cancer Center at University of North Carolina-Chapel Hill, Chapel Hill, USA
| | | | - Ravi Vij
- Washington University School of Medicine, St. Louis, USA
| | - Gary Schiller
- David Geffen School of Medicine at University of California, Los Angeles, USA
| | | | - Joshua Richter
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Klaus Podar
- University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | | | | | - Karlin Lionel
- Centre Hospitalier Lyon Sud, Saint-Genis-Laval, France
| | | | - Jagannath Sundar
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
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15
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Kim SJ, Kang D, Park Y, Mun YC, Kim K, Kim JS, Min CK, Cho J. Impact of depression on adherence to lenalidomide plus low-dose dexamethasone in patients with relapsed or refractory myeloma. Support Care Cancer 2021; 29:4969-4977. [PMID: 33575840 DOI: 10.1007/s00520-021-06017-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE While continued lenalidomide and low-dose dexamethasone (Rd) treatment could improve survival outcomes for multiple myeloma (MM), the association of depression on the adherence to Rd regimen in myeloma patients has never been studied even though depression is a common symptom among MM patients. This study aims to evaluate the impact of depression prior to Rd treatment on adherence to the treatment among patients with MM. METHODS This multicenter cohort study was conducted from January 2015 to October 2018 at five tertiary hospitals in Korea. Patients who completed fewer than 4 cycles, 4-11 cycles, and more than 12 cycles were categorized as the poor adherence group (PAG), moderate adherence group (MAG), and good adherence group (GAG), respectively. RESULTS Among141 patients, 41.8% of them had depression before beginning Rd treatment and 46% of participants were in the GAG. Compared with patients in the GAG (30.3%), patients in the PAG were more likely to have depression at baseline (90.0%) and had the higher distress scores (6.35 vs. 4.28, P < 0.01). Presence of depression prior to Rd treatment was significantly associated with poor adherence (IRR = 6.67, 95% CI = 1.45, 30.61) after adjusting for age, sex, education, ECOG, ISS stage, number of previous treatments, and disease status prior to Rd treatment. CONCLUSIONS Patients with depression had a substantially high risk of poor adherence compared to patients without depression. Given that Rd treatment is mainly offered by outpatient clinics, active interventions to reduce depression should be considered for MM patients prior to Rd treatment.
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Affiliation(s)
- Seok Jin Kim
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, South Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Cancer Education Center, Samsung Comprehensive Cancer Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Park
- Divison of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, Anam Hospital, Seoul, South Korea
| | - Yeung-Chul Mun
- Department of Hematology, Ewha Womans University, Seoul, South Korea
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
| | - Chang-Ki Min
- Division of Hematology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, South Korea. .,Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. .,Cancer Education Center, Samsung Comprehensive Cancer Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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16
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Steinmetz TH, Singh M, Lebioda A, Fink L, Schoehl M, Rieth A, Gonzalez-McQuire S, Engelhardt M. Healthcare resource utilization and costs among patients with relapsed and/or refractory multiple myeloma treated with proteasome inhibitors in real-world clinical practice in Germany. J Med Econ 2021; 24:114-122. [PMID: 33390079 DOI: 10.1080/13696998.2020.1867469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS To assess the real-world healthcare resource utilization (HRU) and costs associated with different proteasome inhibitors (PIs) for the treatment of patients with relapsed and/or refractory multiple myeloma (RRMM) in Germany. METHODS We conducted a retrospective medical chart review of treatment patterns, outcomes, and HRU for patients with RRMM treated with bortezomib, carfilzomib, or ixazomib in second- or third-line (2L or 3L) therapy in Germany. Data were collected between 1 January 2017 and 30 June 2017. Costs were calculated based on drug prices and unit costs in Germany. RESULTS Physicians provided data on 302 patients. Mean monthly total direct costs per patient receiving PI-based therapy were €7,925 and €10,693 for 2L and 3L, respectively, of which approximately 90% was anti-myeloma drug costs. Overall, the highest costs were associated with patients receiving 3L therapy. Regardless of treatment line, costs were higher for patients who had received a stem cell transplant (SCT) in a previous treatment line than for those who had not; the data suggest that this reflects the use of triplet regimens following a SCT. Patients with a complete response (CR) experienced no unplanned hospitalizations during the study period, whereas patients with progressive disease experienced the highest number of unplanned and planned hospitalizations. In 2L therapy, the highest proportion of patients with a CR was observed in those receiving carfilzomib (12% carfilzomib; 4% bortezomib; 0% ixazomib). LIMITATIONS Patients with missing or incomplete follow-up data were included in the study and were accounted for using monthly cost estimates. CONCLUSIONS Anti-myeloma drugs were the main contributor to total HRU costs associated with RRMM in Germany. Improved treatment response was associated with lower costs and reduced hospitalizations.
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Affiliation(s)
| | | | | | - Leah Fink
- Kantar, Health Division, Paris, France
| | | | | | | | - Monika Engelhardt
- Faculty of Freiburg, University Hospital of Freiburg, Freiburg, Germany
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17
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Quality of patient-reported outcome reporting in randomised controlled trials of haematological malignancies according to international quality standards: a systematic review. LANCET HAEMATOLOGY 2020; 7:e892-e901. [DOI: 10.1016/s2352-3026(20)30292-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 11/23/2022]
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18
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Nagarajan C, Tan MS, Chen Y, Martinelli G, Cerchione C. Current and future perspectives of maintenance therapy in multiple myeloma. Panminerva Med 2020; 62:225-233. [PMID: 32955180 DOI: 10.23736/s0031-0808.20.04117-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
While the outcome of patients with multiple myeloma has significantly improved over the last two decades, the disease remains incurable for the majority of patients. With the advent of novel agents, there has been a shift towards prolonged therapy as opposed to fixed-duration therapy, aimed at improving progression-free survival and overall survival. Evidence favoring continuous therapy has emerged over the last 2 decades and in the context of maintenance after proteasome inhibitor plus immunomodulatory drug induction followed by high dose melphalan and stem cell transplantation, this leads to >80% overall survival at 5 years. Maintenance therapy specifically has been demonstrated to correlate with increasing depth of disease response with a significant proportion of patients who remain minimal residual disease positive at the end of induction therapy achieving minimal residual disease negativity with maintenance therapy both in clinical trials and selected real world populations. As the survival improves, it is crucial to identify patients who are projected to have better survival and spare them toxicities arising from indefinite maintenance therapy. The role of minimal residual disease in this context is being investigated in numerous clinical trials and in the next few years the goal should be to use this in a rational way to achieve the ability to identify patients who would require continuation or escalation of therapy to improve their projected survival as well as to identify the group of patients in whom maintenance therapy could perhaps be time-limited without compromising their survival. Here we review the evidence for maintenance therapy from the key trials in the past years, present an overview of the current landscape and our perspective of maintenance therapy in the future.
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Affiliation(s)
- Chandramouli Nagarajan
- Department of Hematology, Singapore General Hospital, Singapore, Singapore - .,SingHealth Duke NUS Blood Cancer Center, Singapore, Singapore -
| | - Melinda S Tan
- Department of Hematology, Singapore General Hospital, Singapore, Singapore
| | - Yunxin Chen
- Department of Hematology, Singapore General Hospital, Singapore, Singapore.,SingHealth Duke NUS Blood Cancer Center, Singapore, Singapore
| | - Giovanni Martinelli
- Unit of Hematology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Claudio Cerchione
- Unit of Hematology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
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19
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Oriol A, Ibarra G, Abella E, Motlló C, Cibeira MT, Garcia A, Escoda L, Granell M, Ben-Azaiz R, Cervera M, Cabezudo E, Fernandez C, Rosiñol L. Impact of response to treatment in health-related quality of life patient-reported outcomes in elderly patients with relapsed multiple myeloma. Leuk Lymphoma 2020; 62:125-135. [PMID: 32933355 DOI: 10.1080/10428194.2020.1817439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Multiple myeloma (MM) is a recurrent malignancy with a high impact on quality of life. Improved survival relies on the combination of drugs and extended duration of therapy, raising concerns on its toxicity burden in elderly patients. Health-related quality of life measurements attent to capture health aspects relevant to patients other than efficacy. This prospective study aimed to understand the relationship between MM-related symptomatology and other quality of life dimensions using the EORTC QLQ-MY20 questionnaire in individuals with relapsed or refractory MM. Irrespective of treatment modality, over 50% of patients who responded to treatment had significant omprovements of reported scores in all domains. Conversely, disease progression was associated with score deterioration not only in the MM-related symptoms domain but also in all other domains. HRQoL adds valuable information to the established efficacy endpoints but an adequate interpretation of HRQoL outcomes in randomized trials should require stratification according to response.
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Affiliation(s)
- Albert Oriol
- Institut Josep Carreras and Institut Catala d'Oncologia, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Gladys Ibarra
- Institut Josep Carreras and Institut Catala d'Oncologia, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Cristina Motlló
- Hematology Department, Hospital Sant Joan de Déu, Manresa, Spain
| | - Maria-Teresa Cibeira
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antoni Garcia
- Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Lourdes Escoda
- Hematology Department, Hospital Universitari de Tarragona Joan XXIII-ICO-Tarragona, Tarragona, Spain
| | - Miquel Granell
- Hematology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Marta Cervera
- Hematology Department, Hospital Universitari de Tarragona Joan XXIII-ICO-Tarragona, Tarragona, Spain
| | - Elena Cabezudo
- Hematology Department, Hospital Sant Joan de Déu, Manresa, Spain
| | - Carlos Fernandez
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
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20
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Li X, Liu J, Chen M, Gu J, Huang B, Zheng D, Li J. Health-related quality of life of patients with multiple myeloma: A real-world study in China. Cancer Med 2020; 9:7896-7913. [PMID: 32881377 PMCID: PMC7643654 DOI: 10.1002/cam4.3391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/30/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose This study aimed to assess the health‐related quality of life (HRQOL) of Chinese patients with different stages of multiple myeloma (MM) who received various treatments and identify the factors associated with a lower quality of life in China. Methods A cross‐sectional, anonymous questionnaire was distributed to adults with MM. The measures of quality of life included the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)‐C30, QLQ‐myeloma‐specific module 20 (MY20), and EuroQoL EQ‐5D. The data, including patient factors, difficulties experienced during the diagnosis and treatment processes, psychosocial factors and disease‐ or treatment‐related effects, were collected. Results Four hundred and thirty patients with MM were recruited from all 27 provinces of China, and their average age was 55.7 years. Many variables were significantly associated with the HRQOL of the patients with MM. In the multivariate analyses, performance status, psychosocial factors, disease phase, and an early diagnosis were significantly associated with the HRQOL. In the subgroup analysis, the HRQOL of the patients who underwent autologous stem cell transplantation (ASCT) was significantly higher than that of the non‐ASCT patients. Treatment‐related toxicities had a significant impact on the quality of life of the patients with MM, and 91.5% of the patients intended to stop the maintenance treatment. Conclusions The quality of life of patients with MM in China is affected by patient factors, difficulties experienced during the diagnosis and treatment processes, psychosocial factors, and disease‐ or treatment‐related effects. Efforts should be exerted to improve the overall quality of life of these patients in China.
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Affiliation(s)
- Xiaozhe Li
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Junru Liu
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Meilan Chen
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jingli Gu
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Beihui Huang
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dong Zheng
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Juan Li
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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21
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Development of a Patient Centered Outcome Set for Patients With Multiple Myeloma to be Used in Clinical Practice. Hemasphere 2020; 4:e366. [PMID: 32647795 PMCID: PMC7306300 DOI: 10.1097/hs9.0000000000000366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/02/2020] [Indexed: 11/27/2022] Open
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22
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Mian H, Pond GR, Tuchman SA, Fiala MA, Wildes TM. Geriatric assessment and quality of life changes in older adults with newly diagnosed multiple myeloma undergoing treatment. J Geriatr Oncol 2020; 11:1279-1284. [PMID: 32471776 DOI: 10.1016/j.jgo.2020.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/28/2020] [Accepted: 05/09/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Multiple myeloma (MM) is a cancer of older adults with a median age at diagnosis of 70 years. Our study aimed to understand the changes that occurred in geriatric domains and quality of life parameters as older adults underwent treatment for MM over 6-months following initial diagnosis. METHODS This was a secondary analysis of a prospective cohort study of 40 adults aged ≥65 with newly-diagnosed MM who completed the Cancer and Aging Research Group geriatric assessment and the Functional Assessment of Cancer Therapy (General and subscale Gynecologic Oncology Group-Neurotoxicity) quality of life tool at baseline and at 6 months following treatment initiation. RESULTS Thirty-six participants completed 6-months of follow-up. There was no significant change in geriatric domains, including dependence in instrumental activities of daily living (IADLs). Compared to baseline, mental health improved at 6-months of follow-up (Mental Health Inventory-17 score, median 77.1 versus 84.3 at baseline and 6-months respectively, p < .001). Objective physical performance as measured by the Timed Up and Go test showed a trend towards improvement (12.3 versus 11.0 s, p = .057) and remained stable or improved in almost all (30/32, 93.8%) of the adults using the minimum clinically important difference threshold. CONCLUSION From baseline to 6-months of follow-up, older adults with MM showed improvement in mental health but otherwise remained stable with regards to function and overall quality of life. Timed Up and Go Test may provide a dynamic indicator of functional status and needs to be further evaluated in future studies.
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Affiliation(s)
- Hira Mian
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
| | - Gregory R Pond
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Sascha A Tuchman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Mark A Fiala
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Tanya M Wildes
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States of America
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23
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Challenges in the cultural adaptation of the German Myeloma Patient Outcome Scale (MyPOS): an outcome measure to support routine symptom assessment in myeloma care. BMC Cancer 2020; 20:245. [PMID: 32293347 PMCID: PMC7092563 DOI: 10.1186/s12885-020-06730-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/09/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients with multiple myeloma report more problems with quality of life (QoL) than other haematological malignancies over the course of their incurable illness. The patient-centred Myeloma Patient Outcome Scale (MyPOS) was developed to assess and monitor symptoms and supportive care factors in routine care. Our aim was to translate and culturally adapt the outcome measure to the German context, and to explore its face and content validity. METHODS Translation and cultural adaptation following established guidelines used an exploratory, sequential mixed method study design. Steps included: (1) forward translation to German; (2) backward translation to English; (3) expert review; (4) focus groups with the target population (patients, family members, healthcare professionals) to achieve conceptual equivalence; (5) cognitive interviews using Tourangeau's model with think-aloud technique to evaluate comprehension and acceptability; (6) final review. Results were analysed using thematic analysis. RESULTS Cultural and linguistic differences were noted between the German and English original version. The focus groups (n = 11) and cognitive interviews (n = 9) both highlighted the need for adapting individual items and their answer options to the German healthcare context. Greater individuality regarding need for information with the right to not be informed was elaborated by patients. While the comprehensive nature of the tool was appreciated, item wording regarding satisfaction with healthcare was deemed not appropriate in the German context. Before implementation into routine care, patients' concerns about keeping their MyPOS data confidential need to be addressed as a barrier, whereas the MyPOS itself was perceived as a facilitator/prompt for a patient-centred discussion of QoL issues. CONCLUSION With adaptations to answer options and certain items, the German version of the MyPOS can help monitor symptoms and problems afflicting myeloma patients over the course of the disease trajectory. It can help promote a model of comprehensive supportive and patient-centred care for these patients.
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24
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Schjesvold F, Goldschmidt H, Maisnar V, Spicka I, Abildgaard N, Rowlings P, Cain L, Romanus D, Suryanarayan K, Rajkumar V, Odom D, Gnanasakthy A, Dimopoulos M. Quality of life is maintained with ixazomib maintenance in post-transplant newly diagnosed multiple myeloma: The TOURMALINE-MM3 trial. Eur J Haematol 2020; 104:443-458. [PMID: 31880006 DOI: 10.1111/ejh.13379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Health-related quality of life (HRQoL) is particularly important during maintenance therapy (MT) in newly diagnosed multiple myeloma post-transplant, when disease symptoms are limited. METHODS We assessed HRQoL in patients randomised to 26 cycles of MT (ixazomib vs placebo) in TOURMALINE-MM3 (NCT02181413). RESULTS The characteristics at study entry were well-balanced between ixazomib (n = 386) and placebo (n = 251) arms. At study entry, EORTC QLQ-C30 and MY20 scores were high for functional scales and low for symptom scales and were comparable with those of the general population. Changes in subscale scores across intervals, analysed over 30 four-week intervals using a linear mixed-effects model, were generally small and similar between arms for the EORTC QLQ-C30 Global Health Status/QoL, Physical Functioning, and Pain subscales and EORTC QLQ-MY20 Disease Symptoms subscale and Peripheral Neuropathy item. EORTC QLQ-C30 Nausea/Vomiting and Diarrhoea subscales were consistently worse for ixazomib than for placebo, in line with the ixazomib toxicity profile. Even when least-squares mean differences between arms were statistically significant, none reached the established minimal important clinical difference of 10 in multiple myeloma. CONCLUSIONS In addition to improvement in progression-free survival with ixazomib, HRQoL was maintained in both arms. Active treatment with ixazomib did not have an adverse impact on HRQoL.
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Affiliation(s)
- Fredrik Schjesvold
- Oslo Myeloma Center, Oslo University Hospital, Oslo, Norway.,KG Jebsen Center for B cell malignancies, University of Oslo, Oslo, Norway
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University Medical Hospital and National Center of Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Vladimir Maisnar
- Department of Medicine-Hematology, Charles University Hospital, Hradec Králové, Czech Republic
| | - Ivan Spicka
- Department of Hematology, Charles University, Prague, Czech Republic
| | - Neils Abildgaard
- Department of Hematology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Philip Rowlings
- Department of Hematology, School of Medicine & Public Health, University of Newcastle, Waratah, New South Wales, Australia
| | - Lauren Cain
- Statistical and Quantitative Sciences, Takeda Pharmaceuticals, Cambridge, MA, USA
| | - Dorothy Romanus
- Global Outcomes Research, Takeda Pharmaceuticals, Cambridge, MA, USA
| | | | - Vincent Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Dawn Odom
- Biostatistics, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Ari Gnanasakthy
- Patient-Centered Outcomes Assessment, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Meletios Dimopoulos
- Department of Clinical Therapeutics, Hematology & Medical Oncology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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25
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Roussel M, Hebraud B, Hulin C, Perrot A, Caillot D, Stoppa AM, Macro M, Escoffre M, Arnulf B, Belhadj K, Karlin L, Garderet L, Facon T, Guo S, Weng J, Dhanasiri S, Leleu X, Moreau P, Attal M. Health-related quality of life results from the IFM 2009 trial: treatment with lenalidomide, bortezomib, and dexamethasone in transplant-eligible patients with newly diagnosed multiple myeloma. Leuk Lymphoma 2020; 61:1323-1333. [DOI: 10.1080/10428194.2020.1719091] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Murielle Roussel
- Institut Universitaire du Cancer de Toulouse-Oncopole and University Hospital, Toulouse, France
| | - Benjamin Hebraud
- Institut Universitaire du Cancer de Toulouse-Oncopole and University Hospital, Toulouse, France
| | | | | | | | | | | | - Martine Escoffre
- Hematologie clinique, Institut Paoli-Calmettes, Marseille, France
| | | | | | - Lionel Karlin
- Hématologie clinique, CHU de Lyon HCL – GH Sud, Pierre-Bénite, France
| | | | | | | | | | - Sujith Dhanasiri
- Celgene International, A Bristol-Myers Squibb Company, Boudry, Switzerland
| | | | | | - Michel Attal
- Institut Universitaire du Cancer de Toulouse-Oncopole and University Hospital, Toulouse, France
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26
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Abstract
BACKGROUND Multiple myeloma is a B-cell haematological malignancy characterised by uncontrolled plasma cell proliferation. Patients with the disease often undergo periods of remission followed by multiple relapses. Understanding patients' experience of living with this chronic condition is key to providing effective patient-centred care. AIMS This qualitative descriptive study explored the experiences of patients living with multiple myeloma. METHODS A purposive sample of 6 patients was used. Data were collected using in-depth unstructured interviews and analysed using Colaizzi's (1978) thematic framework. FINDINGS The emergent themes included: information and communication; treatment and symptom burden; the importance of support from family/friends and professional help; psychosocial elements of survivorship. CONCLUSION The complex symptoms of multiple myeloma need to be treated holistically to manage the unpredictable nature of this disease.
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Affiliation(s)
- Clare Horgan Cuffe
- Clinical Nurse Specialist, Haematology Day Unit, Tallaght University Hospital, Dublin
| | - Mary B Quirke
- Research Felllow, Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin
| | - Catherine McCabe
- Associate Professor, School of Nursing and Midwifery, Trinity College Dublin
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27
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Weisel K, Ludwig H, Rieth A, Lebioda A, Goldschmidt H. Health-related quality of life of carfilzomib- and daratumumab-based therapies in patients with relapsed/refractory multiple myeloma, based on German benefit assessment data. Qual Life Res 2020; 29:69-79. [PMID: 31552577 PMCID: PMC6962286 DOI: 10.1007/s11136-019-02307-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Carfilzomib and daratumumab are licensed in relapsed/refractory multiple myeloma (RRMM), but no head-to-head trials have been conducted. METHODS We used data from dossiers prepared for the German Federal Joint Committee based on two phase III randomized trials of carfilzomib-based therapies (ASPIRE, ENDEAVOR) and two of daratumumab-based therapies (POLLUX, CASTOR) to conduct a descriptive assessment of health-related quality of life (HRQoL). HRQoL was assessed using the European Organisation for Research and Treatment of Cancer 30-item HRQoL Questionnaire, with hazard ratios calculated for carfilzomib- and daratumumab-based therapy versus comparators for time to HRQoL deterioration of ≥ 10 points. Analyses were also conducted on data from the EORTC 20-item myeloma-specific questionnaire, the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity scale, and the visual analog scale of the EuroQoL 5-dimension, 5-level questionnaire, where results for these instruments were available. As the designs and patient population of the four trials were similar but not identical, the analysis included only indirect, descriptive comparisons. RESULTS Compared with lenalidomide/dexamethasone, median time to deterioration in global health status/QoL was longer for carfilzomib-based therapy versus control, but similar for daratumumab-based therapy and control. Compared with bortezomib/dexamethasone, time to deterioration was significantly longer for carfilzomib-based therapy versus control for global health status/QoL and numerous functional and symptom subscales. HRQoL measurement is feasible in large RRMM populations. CONCLUSION Descriptive assessment of HRQoL data suggests potential benefits for carfilzomib-based over daratumumab-based therapy.
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Affiliation(s)
- Katja Weisel
- Medizinische Klinik und Poliklinik (Onkologie, Hämatologie, Knochenmarktransplantation mit Abteilung für Pneumologie), Universitätsklinikum Hamburg - Eppendorf, II., Martinistr. 52, 20246, Hamburg, Germany.
- Department of Medicine II, University Hospital Tubingen, Tübingen, Germany.
| | - Heinz Ludwig
- 1st Department of Medicine, Wilhelminen Cancer Research Institute, Vienna, Austria
| | | | | | - Hartmut Goldschmidt
- Internal Medicine V and National Center for Tumor Diseases (NCT), University Clinic Heidelberg, Heidelberg, Germany
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28
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Ludwig H, Pönisch W, Knop S, Egle A, Hinke A, Schreder M, Lechner D, Hajek R, Gunsilius E, Petzer A, Weisel K, Niederwieser D, Einsele H, Willenbacher W, Rumpold H, Pour L, Jelinek T, Krenosz KJ, Meckl A, Nolte S, Melchardt T, Greil R, Zojer N. Quality of life in patients with relapsed/refractory multiple myeloma during ixazomib-thalidomide-dexamethasone induction and ixazomib maintenance therapy and comparison to the general population. Leuk Lymphoma 2019; 61:377-386. [PMID: 31556753 DOI: 10.1080/10428194.2019.1666381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This trial evaluated quality of life (QoL) using the EORTC QLQ-C30 and the EORTC QLQ-MY20 instruments in 90 patients with relapsed/refractory multiple myeloma during induction and maintenance therapy with eight cycles of ixazomib-thalidomide-dexamethasone, followed by 12 months of ixazomib maintenance therapy. When patient's baseline QoL was compared with data of the general population, a significant impairment in health-related QoL, physical, role, and social functioning and several other dimensions, as well as more pain and fatigue, was noted. Induction therapy resulted in significant improvement of pain and worsening of neuropathy, with no significant variation of other parameters. During maintenance treatment, scores for most dimensions including health-related QoL, physical functioning and pain, improved, while for neuropathy no improvement was observed. Time to deterioration (≥10 score points) of health-related QoL, physical functioning, pain, and neuropathy was distinctly shorter than time to progression. Health-related QoL and physical functioning at baseline correlated with overall survival.
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Affiliation(s)
- Heinz Ludwig
- Wilhelminen Cancer Research Institute, Department of Medicine I, Center for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria
| | - Wolfram Pönisch
- Department of Hematology, University of Leipzig, Leipzig, Germany
| | - Stefan Knop
- Division of Hematology and Medical Oncology, Department of Internal Medicine II, Wuerzburg University Medical Center, Wuerzburg, Germany
| | - Alexander Egle
- Department of Internal Medicine III with Haematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute - Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Austria
| | - Axel Hinke
- CCRC Cancer Clinical Research Consulting, Düsseldorf, Germany
| | - Martin Schreder
- Department of Medicine I, Center for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria
| | - Daniel Lechner
- Department of Medicine I, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Roman Hajek
- Fakultní Nemocnice Ostrava, Ostrava, Czech Republic
| | - Eberhard Gunsilius
- Department of Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria
| | - Andreas Petzer
- Department of Internal Medicine I, Ordensklinikum Linz - Barmherzige Schwestern, Linz, Austria
| | - Katja Weisel
- University Medical Center of Hamburg-Eppendorf, Hamburg, Germany
| | | | - Hermann Einsele
- Division of Hematology and Medical Oncology, Department of Internal Medicine II, Wuerzburg University Medical Center, Wuerzburg, Germany
| | - Wolfgang Willenbacher
- Department of Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria.,Oncotyrol, Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Holger Rumpold
- Department of Oncology, Hematology and Gastroenterology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | | | - Karl Jochen Krenosz
- Department of Internal Medicine 3, Kepler Universitaetsklinikum GmbH, Med. Campus III, Linz, Austria
| | - Angela Meckl
- Wilhelminen Cancer Research Institute, Department of Medicine I, Center for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria
| | - Sandra Nolte
- Medical Department, Division of Psychosomatic Medicine, Charité- Universitätsmedizin, Berlin, Germany
| | - Thomas Melchardt
- Department of Internal Medicine III with Haematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute - Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute - Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Austria
| | - Niklas Zojer
- Department of Medicine I, Center for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria
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29
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Sully K, Trigg A, Bonner N, Moreno-Koehler A, Trennery C, Shah N, Yucel E, Panjabi S, Cocks K. Estimation of minimally important differences and responder definitions for EORTC QLQ-MY20 scores in multiple myeloma patients. Eur J Haematol 2019; 103:500-509. [PMID: 31444815 PMCID: PMC6852250 DOI: 10.1111/ejh.13316] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 02/06/2023]
Abstract
Objectives Thresholds for the minimally important difference (MID) or responder definition (RD) in health‐related quality‐of‐life (HRQoL) scores are required to interpret the impact of an intervention or change in the trajectory of the condition which is meaningful to patients. This study aimed to establish MID and RD for the European Organisation for Research and Treatment of Cancer Quality of Life Multiple Myeloma questionnaire (EORTC QLQ‐MY20). Methods A novel mixed‐methods approach was applied by utilizing both existing clinical trial data and prospective patient interviews. Anchor‐based, distribution‐based, and qualitative‐based estimates of meaningful change were triangulated to form recommended RDs for each scale of the EORTC QLQ‐MY20. Anchor‐based MIDs were summarized using weighted correlation. Results Recommended MIDs were as follows: Disease Symptoms (DS 10 points), Side Effects of Treatment (SE 10 points), Body Image (BI 13 points), and Future Perspective (FP 9 points). Recommended RDs were as follows: DS (16 improvement; 11 worsening), SE (6 improvement; 9 worsening), BI (33 improvement; 33 worsening), and FP (11 improvement; 11 worsening). Conclusions The study generated estimates of the MID and RD for each scale of the EORTC QLQ‐MY20. Published estimates will enable investigators and clinicians to adopt these as standard for interpretation and for hypothesis testing. Consequently, analyses from trials of different interventions can be more comparable.
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Affiliation(s)
| | | | | | | | | | - Nina Shah
- Amgen Inc, Thousand Oaks, CA, USA.,University of California, San Francisco, CA, USA
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30
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LeBlanc TW, Baile WF, Eggly S, Bylund CL, Kurtin S, Khurana M, Najdi R, Blaedel J, Wolf JL, Fonseca R. Review of the patient-centered communication landscape in multiple myeloma and other hematologic malignancies. PATIENT EDUCATION AND COUNSELING 2019; 102:1602-1612. [PMID: 31076236 DOI: 10.1016/j.pec.2019.04.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/25/2019] [Accepted: 04/25/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To identify factors limiting and facilitating patient-centered communication (PCC) in the United States hematology-oncology setting, with a focus on multiple myeloma (MM), given the limited attention to PCC and rapid pace of change that has taken place in this setting. METHODS A literature search was performed from 2007 to 2017 to identify published articles and congress abstracts related to clinician-patient communication and treatment decision-making in oncology. Search results were evaluated by year of publication and disease area. A thematic assessment was performed to identify factors limiting and promoting PCC for patients with MM and other hematologic malignancies. RESULTS Of the 6673 publications initially retrieved, 18 exclusively reported findings in patients with hematologic malignancies and were included in this review. We identified three critical, but modifiable, barriers to PCC in the hematologic malignancy setting, including insufficient information exchange, treatment goal misalignment, and discordant role preferences in treatment decision-making. Factors that enhanced interaction quality included educational programs for clinicians and patients. CONCLUSIONS Patients with MM and other hematologic malignancies experience a distinct set of challenges that may affect PCC. PRACTICE IMPLICATIONS Clinicians have the opportunity to improve patient care by proactively addressing the identified barriers and implementing strategies demonstrated to improve PCC.
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Affiliation(s)
- Thomas W LeBlanc
- Duke Cancer Institute, Durham, NC, USA; Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - Walter F Baile
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan Eggly
- Wayne State University Department of Oncology/Karmanos Cancer Institute, Detroit, MI, USA
| | - Carma L Bylund
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA; College of Medicine, University of Florida, Gainesville, FL, USA
| | - Sandra Kurtin
- University of Arizona and Arizona Cancer Center, Tucson, AZ, USA
| | | | | | | | - Jeffrey L Wolf
- Department of Medicine, Division of Hematology & Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Rafael Fonseca
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
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31
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Kang HY, Choi EY. Factors influencing quality of life in patients with multiple myeloma. Contemp Nurse 2019; 55:109-121. [DOI: 10.1080/10376178.2019.1623699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Hee-Young Kang
- Department of Nursing, Chosun University, 309, Pilmundaero, Dong-gu, Gwangju 61452, South Korea
| | - Eun-Young Choi
- Department of Nursing, Chosun Nursing College, 309-2, Pilmundaero, Dong-gu, Gwangju 61453, South Korea
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32
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Convenience, satisfaction, health-related quality of life of once-weekly 70 mg/m2 vs. twice-weekly 27 mg/m2 carfilzomib (randomized A.R.R.O.W. study). Leukemia 2019; 33:2934-2946. [DOI: 10.1038/s41375-019-0480-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/14/2019] [Accepted: 03/20/2019] [Indexed: 11/12/2022]
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33
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Costello C, Davies FE, Cook G, Vela-Ojeda J, Omel J, Rifkin RM, Berdeja J, Puig N, Usmani SZ, Weisel K, Zonder JA, Terpos E, Spencer A, Leleu X, Boccadoro M, Thompson MA, Romanus D, Stull DM, Hungria V. INSIGHT MM: a large, global, prospective, non-interventional, real-world study of patients with multiple myeloma. Future Oncol 2019; 15:1411-1428. [PMID: 30816809 PMCID: PMC6854441 DOI: 10.2217/fon-2019-0013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/07/2019] [Indexed: 12/27/2022] Open
Abstract
With the introduction of new drugs with different mechanisms of action, multiple myeloma (MM) patients' outcomes have improved. However, the efficacy seen in clinical trials is often not seen in real-world settings and data on the effectiveness of MM therapies are needed. INSIGHT MM is a prospective, global, non-interventional, observational study that is enrolling approximately 4200 patients with newly diagnosed or relapsed/refractory MM, making it the largest study of its kind to date. The study aims to describe contemporary, real-world patterns of patient characteristics, clinical disease presentation, therapies chosen, clinical outcomes (response, treatment duration, time-to-next-therapy, progression-free and overall survival), safety, healthcare resource utilization and quality of life. One interim analysis has been conducted to date; current accrual is approximately 3094 patients. Trial registration number: NCT02761187.
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Affiliation(s)
- Caitlin Costello
- Department of Medicine, Division of Blood and Marrow Transplantation, Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA
| | - Faith E Davies
- Myeloma Institute, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA
| | - Gordon Cook
- Department of Haematology, Leeds Cancer Centre, St James's University Hospital, Leeds, UK
| | - Jorge Vela-Ojeda
- Hematology Department, La Raza Medical Center, IMSS, México City, México
| | - Jim Omel
- The Central Nebraska Myeloma Support Group, Grand Island, NE 68801, USA
| | - Robert M Rifkin
- Department of Hematology Research, US Oncology Research/Rocky Mountain Cancer Centers, Denver, CO 80218, USA
| | - Jesus Berdeja
- Department of Hematology, Sarah Cannon Research Institute, Nashville, TN 37203, USA
| | - Noemi Puig
- Department of Hematology, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Saad Z Usmani
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Charlotte, NC 28204, USA
| | - Katja Weisel
- Department of Hematology, University of Tuebingen, Tuebingen, Germany
- Department of Oncology, Hematology & Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jeffrey A Zonder
- Department of Oncology, Barbara Ann Karmanos Cancer Institute/Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Andrew Spencer
- Department of Clinical Haematology, Alfred Health-Monash University, Melbourne, Australia
| | - Xavier Leleu
- Pôle Régional de Cancérologie and CIC1402 INSERM, CHU de Poitiers, France
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Torino, Italy
| | | | - Dorothy Romanus
- Global Outcomes Research, Millennium Pharmaceuticals, Inc., Cambridge, MA 02139, USA
| | - Dawn M Stull
- Global Medical Affairs, Millenium Pharmaceuticals, Inc., Cambridge, MA 02139, USA
| | - Vania Hungria
- Department of Hematology, Clinica São Germano and Santa Casa Medical School, São Paulo, Brazil
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Costello C, Davies FE, Cook G, Vela-Ojeda J, Omel J, Rifkin RM, Berdeja J, Puig N, Usmani SZ, Weisel K, Zonder JA, Terpos E, Spencer A, Leleu X, Boccadoro M, Thompson MA, Romanus D, Stull DM, Hungria V. INSIGHT MM: a large, global, prospective, non-interventional, real-world study of patients with multiple myeloma. Future Oncol 2019. [DOI: 10.2217/fon-2019-0013 and 21=21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
With the introduction of new drugs with different mechanisms of action, multiple myeloma (MM) patients’ outcomes have improved. However, the efficacy seen in clinical trials is often not seen in real-world settings and data on the effectiveness of MM therapies are needed. INSIGHT MM is a prospective, global, non-interventional, observational study that is enrolling approximately 4200 patients with newly diagnosed or relapsed/refractory MM, making it the largest study of its kind to date. The study aims to describe contemporary, real-world patterns of patient characteristics, clinical disease presentation, therapies chosen, clinical outcomes (response, treatment duration, time-to-next-therapy, progression-free and overall survival), safety, healthcare resource utilization and quality of life. One interim analysis has been conducted to date; current accrual is approximately 3094 patients. Trial registration number: NCT02761187
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Affiliation(s)
- Caitlin Costello
- Department of Medicine, Division of Blood and Marrow Transplantation, Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA
| | - Faith E Davies
- Myeloma Institute, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA
| | - Gordon Cook
- Department of Haematology, Leeds Cancer Centre, St James's University Hospital, Leeds, UK
| | - Jorge Vela-Ojeda
- Hematology Department, La Raza Medical Center, IMSS, México City, México
| | - Jim Omel
- The Central Nebraska Myeloma Support Group, Grand Island, NE 68801, USA
| | - Robert M Rifkin
- Department of Hematology Research, US Oncology Research/Rocky Mountain Cancer Centers, Denver, CO 80218, USA
| | - Jesus Berdeja
- Department of Hematology, Sarah Cannon Research Institute, Nashville, TN 37203, USA
| | - Noemi Puig
- Department of Hematology, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Saad Z Usmani
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Charlotte, NC 28204, USA
| | - Katja Weisel
- Department of Hematology, University of Tuebingen, Tuebingen, Germany
- Department of Oncology, Hematology & Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jeffrey A Zonder
- Department of Oncology, Barbara Ann Karmanos Cancer Institute/Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Andrew Spencer
- Department of Clinical Haematology, Alfred Health-Monash University, Melbourne, Australia
| | - Xavier Leleu
- Pôle Régional de Cancérologie and CIC1402 INSERM, CHU de Poitiers, France
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Torino, Italy
| | | | - Dorothy Romanus
- Global Outcomes Research, Millennium Pharmaceuticals, Inc., Cambridge, MA 02139, USA
| | - Dawn M Stull
- Global Medical Affairs, Millenium Pharmaceuticals, Inc., Cambridge, MA 02139, USA
| | - Vania Hungria
- Department of Hematology, Clinica São Germano and Santa Casa Medical School, São Paulo, Brazil
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A phase 1b study of isatuximab plus pomalidomide/dexamethasone in relapsed/refractory multiple myeloma. Blood 2019; 134:123-133. [PMID: 30862646 DOI: 10.1182/blood-2019-02-895193] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/28/2019] [Indexed: 01/07/2023] Open
Abstract
This phase 1b dose-escalation study evaluated isatuximab plus pomalidomide/dexamethasone in patients with relapsed/refractory multiple myeloma (RRMM). Patients who had received ≥2 prior MM therapies, including lenalidomide and a proteasome inhibitor (PI), were enrolled and received isatuximab at 5, 10, or 20 mg/kg (weekly for 4 weeks, followed by every 2 weeks), pomalidomide 4 mg (days 1-21), and dexamethasone 40 mg (weekly) in 28-day cycles until progression/intolerable toxicity. The primary objective was to determine the safety and recommended dose of isatuximab with this combination. Secondary objectives included evaluation of pharmacokinetics, immunogenicity, and efficacy. Forty-five patients received isatuximab (5 [n = 8], 10 [n = 31], or 20 [n = 6] mg/kg). Patients received a median of 3 (range, 1-10) prior lines; most were refractory to their last regimen (91%), with 82% lenalidomide-refractory and 84% PI-refractory. Median treatment duration was 9.6 months; 19 patients (42%) remain on treatment. Most common adverse events included fatigue (62%), and upper respiratory tract infection (42%), infusion reactions (42%), and dyspnea (40%). The most common grade ≥3 treatment-emergent adverse event was pneumonia, which occurred in 8 patients (17.8%). Hematologic laboratory abnormalities were common (lymphopenia, leukopenia, anemia, 98% each; neutropenia, 93%; and thrombocytopenia, 84%). Overall response rate was 62%; median duration of response was 18.7 months; median progression-free survival was 17.6 months. These results demonstrate potential meaningful clinical activity and a manageable safety profile of isatuximab plus pomalidomide/dexamethasone in heavily pretreated patients with RRMM. The 10 mg/kg weekly/every 2 weeks isatuximab dose was selected for future studies. This trial was registered at www.clinicaltrials.gov as #NCT02283775.
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Health-related quality of life in the ENDEAVOR study: carfilzomib-dexamethasone vs bortezomib-dexamethasone in relapsed/refractory multiple myeloma. Blood Cancer J 2019; 9:23. [PMID: 30796199 PMCID: PMC6386751 DOI: 10.1038/s41408-019-0181-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 01/14/2019] [Accepted: 01/21/2019] [Indexed: 12/11/2022] Open
Abstract
We examined effects of carfilzomib-dexamethasone (Kd56) versus bortezomib-dexamethasone (Vd) on health-related quality of life (HR-QoL) in relapsed/refractory multiple myeloma (MM) patients from the ENDEAVOR study. HR-QoL was assessed by the European Organisation for Research and Treatment of Cancer QoL Questionnaire (QLQ-C30), MM-specific module (QLQ-MY20), and Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT-GOG-Ntx) “Additional Concerns” neurotoxicity subscale. The QLQ-C30 Global Health Status (GHS)/QoL scale and seven prespecified subscales were compared between groups using mixed model for repeated measures. Of 929 randomized patients, 911 with ≥1 post-baseline assessment were included. Kd56 was associated with statistically significant improvements in GHS/QoL, fatigue, pain, side effects, and FACT/GOG-Ntx scores versus Vd, although mean differences did not meet thresholds for clinical significance. The Kd56 group had longer time to deterioration (TTD) in GHS/QoL (median 3.7 versus 2.8 months, p = 0.0046), physical function (5.6 versus 3.7 months, p = 0.0390), nausea/vomiting (17.6 versus 8.2 months, p = 0.0358), side effects (6.4 versus 3.7 months p < 0.0001), and FACT/GOG-Ntx (11.1 versus 5.5 months, p = 0.0004). Overall, Kd56 resulted in statistically but not clinically significant improvements in mean GHS/QoL scores versus Vd. Treatment with Kd56 versus Vd also significantly prolonged TTD in GHS/QoL, physical function, nausea/vomiting, side effects, and FACT/GOG-Ntx.
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Is lenalidomide the standard-of-care after an autotransplant for plasma cell myeloma? Leukemia 2019; 33:588-596. [DOI: 10.1038/s41375-019-0383-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/21/2018] [Accepted: 09/28/2018] [Indexed: 01/30/2023]
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Nielsen LK, Abildgaard N, Jarden M, Klausen TW. Methodological aspects of health-related quality of life measurement and analysis in patients with multiple myeloma. Br J Haematol 2019; 185:11-24. [PMID: 30656677 DOI: 10.1111/bjh.15759] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Multiple myeloma (MM) is an incurable but treatment-sensitive cancer. For most patients, this means treatment with multiple lines of anti-myeloma therapy and a life with disease- and treatment-related symptoms and complications. Health-related quality of life (HRQoL) issues play an important role in treatment decision-making. Methodological challenges in longitudinal HRQoL measurements and analyses have been identified, including non-responses (NR) to scheduled questionnaires. Publications were identified for inclusion in a systematic review of longitudinal HRQoL studies in MM, focussing on methodological aspects of HRQoL measurement and analysis. Diversity in timing of HRQoL data collection and applied statistical methods were noted. We observed a high rate of NR, but the impact of NR was investigated in only 8/23 studies. Thus, evidence-based knowledge of HRQoL in patients with MM is compromised. To improve quality of HRQoL results and their implementation in daily practice, future studies should follow established guidelines.
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Affiliation(s)
- Lene Kongsgaard Nielsen
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark.,The Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Niels Abildgaard
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark.,The Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Mary Jarden
- Department of Haematology, Copenhagen University Hospital, Copenhagen, Denmark
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Health-Related Quality of Life of Patients With Multiple Myeloma Treated in Routine Clinical Practice in France. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e13-e28. [DOI: 10.1016/j.clml.2018.08.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/17/2018] [Accepted: 08/31/2018] [Indexed: 11/19/2022]
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Richardson PG, Zweegman S, O’Donnell EK, Laubach JP, Raje N, Voorhees P, Ferrari RH, Skacel T, Kumar SK, Lonial S. Ixazomib for the treatment of multiple myeloma. Expert Opin Pharmacother 2018; 19:1949-1968. [DOI: 10.1080/14656566.2018.1528229] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Paul G. Richardson
- Division of Hematologic Malignancy, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Jacob P. Laubach
- Division of Hematologic Malignancy, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Noopur Raje
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Peter Voorhees
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Renda H. Ferrari
- Global Medical Affairs, Millennium Pharmaceuticals, Inc, Cambridge, MA, USA
| | - Tomas Skacel
- Global Medical Affairs, Millennium Pharmaceuticals, Inc, Cambridge, MA, USA
| | | | - Sagar Lonial
- Hematology & Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
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Thanarajasingam G, Minasian LM, Baron F, Cavalli F, De Claro RA, Dueck AC, El-Galaly TC, Everest N, Geissler J, Gisselbrecht C, Gribben J, Horowitz M, Ivy SP, Jacobson CA, Keating A, Kluetz PG, Krauss A, Kwong YL, Little RF, Mahon FX, Matasar MJ, Mateos MV, McCullough K, Miller RS, Mohty M, Moreau P, Morton LM, Nagai S, Rule S, Sloan J, Sonneveld P, Thompson CA, Tzogani K, van Leeuwen FE, Velikova G, Villa D, Wingard JR, Wintrich S, Seymour JF, Habermann TM. Beyond maximum grade: modernising the assessment and reporting of adverse events in haematological malignancies. Lancet Haematol 2018; 5:e563-e598. [PMID: 29907552 PMCID: PMC6261436 DOI: 10.1016/s2352-3026(18)30051-6] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 02/06/2023]
Abstract
Tremendous progress in treatment and outcomes has been achieved across the whole range of haematological malignancies in the past two decades. Although cure rates for aggressive malignancies have increased, nowhere has progress been more impactful than in the management of typically incurable forms of haematological cancer. Population-based data have shown that 5-year survival for patients with chronic myelogenous and chronic lymphocytic leukaemia, indolent B-cell lymphomas, and multiple myeloma has improved markedly. This improvement is a result of substantial changes in disease management strategies in these malignancies. Several haematological malignancies are now chronic diseases that are treated with continuously administered therapies that have unique side-effects over time. In this Commission, an international panel of clinicians, clinical investigators, methodologists, regulators, and patient advocates representing a broad range of academic and clinical cancer expertise examine adverse events in haematological malignancies. The issues pertaining to assessment of adverse events examined here are relevant to a range of malignancies and have been, to date, underexplored in the context of haematology. The aim of this Commission is to improve toxicity assessment in clinical trials in haematological malignancies by critically examining the current process of adverse event assessment, highlighting the need to incorporate patient-reported outcomes, addressing issues unique to stem-cell transplantation and survivorship, appraising challenges in regulatory approval, and evaluating toxicity in real-world patients. We have identified a range of priority issues in these areas and defined potential solutions to challenges associated with adverse event assessment in the current treatment landscape of haematological malignancies.
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Affiliation(s)
| | - Lori M Minasian
- National Cancer Institute, National Institutes of Health, Department of Health & Human Services, Bethesda, MD, USA
| | - Frederic Baron
- Division of Haematology, University of Liege, Liege, Belgium
| | - Franco Cavalli
- Oncology Institute of Southern Switzerland, Bellinzona, Switzlerand
| | - R Angelo De Claro
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Amylou C Dueck
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, USA
| | - Tarec C El-Galaly
- Department of Haematology, Aalborg University Hospital, Aalborg Denmark
| | - Neil Everest
- Haematology Clinical Evaluation Unit, Therapeutic Goods Administration, Department of Health, Symondston, ACT, Australia
| | - Jan Geissler
- Leukaemia Patient Advocates Foundation, Bern, Switzerland
| | - Christian Gisselbrecht
- Haemato-Oncology Department, Hopital Saint-Louis, Paris Diderot University VII, Paris, France
| | - John Gribben
- Centre for Haemato-Oncology, Barts Cancer Institute, London, UK
| | - Mary Horowitz
- Division of Haematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - S Percy Ivy
- National Cancer Institute, National Institutes of Health, Department of Health & Human Services, Bethesda, MD, USA
| | - Caron A Jacobson
- Division of Haematologic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Armand Keating
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Paul G Kluetz
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Aviva Krauss
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Yok Lam Kwong
- Department of Haematology and Haematologic Oncology, University of Hong Kong, Hong Kong, China
| | - Richard F Little
- National Cancer Institute, National Institutes of Health, Department of Health & Human Services, Bethesda, MD, USA
| | | | - Matthew J Matasar
- Lymphoma and Adult BMT Services, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Robert S Miller
- CancerLinQ, American Society of Clinical Oncology, Alexandria, VA, USA
| | - Mohamad Mohty
- Haematology and Cellular Therapy Department, Saint-Antoine Hospital, University Pierre & Marie Curie, Paris, France
| | | | - Lindsay M Morton
- National Cancer Institute, National Institutes of Health, Department of Health & Human Services, Bethesda, MD, USA
| | - Sumimasa Nagai
- University of Tokyo, Tokyo, Japan; Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Simon Rule
- Plymouth University Medical School, Plymouth, UK
| | - Jeff Sloan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Pieter Sonneveld
- Department of Haematology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | | | | | - Galina Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Diego Villa
- Division of Medical Oncology, British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada
| | - John R Wingard
- Division of Haematology & Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Sophie Wintrich
- Myelodysplastic Syndrome (MDS) Alliance and MDS UK Patient Support Group, London, UK
| | - John F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Royal Melbourne Hospital, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
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de Wet R, Lane H, Tandon A, Augustson B, Joske D. 'It is a journey of discovery': living with myeloma. Support Care Cancer 2018; 27:2435-2442. [PMID: 30368672 DOI: 10.1007/s00520-018-4502-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 10/04/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE Although multiple myeloma (MM) is incurable, many people live with the disease for a number of years. Thus, understanding the effect of the disease and its therapies on the lives of those with MM is important. This qualitative study explores the impact of MM and its treatments on patients. METHODS People with newly diagnosed or relapsed MM were recruited from a tertiary institution. Participants were interviewed using a semi-structured approach. The questions were designed to obtain insight into how participants viewed their diagnosis, treatment, and symptoms and how these had impacted on their lives. Data were analysed using a phenomenological approach. RESULTS Fifteen people with MM with a mean age of 62 were recruited. Participants' mean time since diagnosis was 2.7 years and they had received a mean of 1.7 lines of therapy. The first major theme to emerge was lifestyle changes. Interviewees described MM as causing changes to all aspects of their lives, including substantial functional changes, as well as changes to employment, relationships, and their sense of self. The second major theme was 'adjust, adjust, adjust'. Alongside challenging life changes, participants described a range of practical, psychological, and relational approaches to adjusting to living with MM. CONCLUSION This study highlights the importance of and the need for improved supportive care in patients with MM, ideally with a multidisciplinary approach. It also identifies the potential for further investigation of patient approaches to adjusting to MM and development of support strategies.
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Affiliation(s)
- Rosslyn de Wet
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia.
| | - Heather Lane
- Rockingham General Hospital, Elanora Dr, Cooloongup, WA, 6168, Australia
| | - Anil Tandon
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia
| | - Bradley Augustson
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia
| | - David Joske
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia
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Qerimi V, Nestorovska AK, Sterjev Z, Genadieva-Stavric S, Suturkova L. Cost-effectiveness analysis of treating transplant-eligible multiple myeloma patients in Macedonia. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:327-338. [PMID: 29950875 PMCID: PMC6016005 DOI: 10.2147/ceor.s152437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Purpose A decision-analytic model was developed to study the impact of induction regimens vincristine, adriamycin, dexamethasone (VAD); thalidomide, dexamethasone (TD); and bortezomib, dexamethasone (BorD), followed by autologous stem cell transplantation (ASCT) for treating multiple myeloma (MM) patients in Macedonia. Additionally, a cost-effectiveness analysis (CEA) of treatment sequences to predict health effects and costs of different treatment sequences was performed. Methods Model strategies were based on a previously published study for treating patients with MM in Macedonia. The data on disease progression and treatment effectiveness were obtained from the published reports of randomized clinical trials (GIMEMA M-B02005, IFM 2005-01). Utility parameters were extracted from the literature. To compare treatment combinations, a decision tree model was developed. Additionally, a cost analysis for one-time per-protocol costs was performed from a Macedonian national health care perspective. The incremental cost-effectiveness ratios (ICERs)/quality-adjusted life years (QALYs) gained for 1-, 10-, and 20-year time horizons were determined. Costs and health outcomes were discounted to evaluate the effects of time in the model. Results The one-time costs of BorD (EUR 5,656) were higher compared to VAD (EUR 303) and TD (EUR 329), increasing the overall costs for BorD. Thus, the BorD combination dominated in the baseline results (1 and 10 years) and the ICER for TD vs. VAD was EUR 7,564/QALY (20 years, undiscounted model). However, in the discounted 20-year model, BorD showed an ICER of EUR 138,747/QALY gained for BorD vs. TD. Conclusion The CEA performed indicated that considering 1-year time horizon costs, VAD may be a cost-effective alternative vs. TD or BorD. However, for the longer period (10 or 20 years) including the discounting of future costs and outcomes, the TD and BorD combinations showed higher health benefits in terms of QALYs and more cost-effective vs. VAD. These results should be considered as supportive evidence by decision-makers and providers when deciding on the most cost-effective induction treatment strategy prior to ASCT in MM patients.
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Affiliation(s)
- Vjollca Qerimi
- Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, Skopje, Macedonia.,Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | | | - Zoran Sterjev
- Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, Skopje, Macedonia
| | | | - Ljubica Suturkova
- Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, Skopje, Macedonia
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Efficace F, Boccadoro M, Palumbo A, Petrucci MT, Cottone F, Cannella L, Zamagni E, Niscola P, Kyriakou C, Caravita T, Offidani M, Mandelli F, Cavo M. A prospective observational study to assess clinical decision-making, prognosis, quality of life and satisfaction with care in patients with relapsed/refractory multiple myeloma: the CLARITY study protocol. Health Qual Life Outcomes 2018; 16:127. [PMID: 29914509 PMCID: PMC6006751 DOI: 10.1186/s12955-018-0953-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 06/04/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Treatment decision-making in patients with relapsed/refractory multiple myeloma (RRMM) is challenging for a number of reasons including, the heterogeneity of disease at relapse and the number of possible therapeutic approaches. This study broadly aims to generate new evidence-based data to facilitate clinical decision-making in RRMM patients. The primary objective is to investigate the prognostic value of patient self-reported fatigue severity for overall survival. METHODS This multicenter prospective observational study will consecutively enroll 312 patients with multiple myeloma who have received at least 1 prior line of therapy and are considered as RRMM according to the International Myeloma Working Group (IMWG) criteria. Eligible RRMM participants will be adults (≥ 18 years old) patients and will be enrolled irrespective of comorbidities and performance status. At the time of study inclusion, data to calculate the frailty score are to be available. Patients will be followed up for 30 months and patient-reported outcome (PRO) assessment is planned at baseline and thereafter at 3, 6, 12, and 24 months. The following PRO validated questionnaires will be used: the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), the EORTC QLQ-MY20 and the EORTC QLQ-INFO25. Satisfaction with care and preference for involvement in treatment decisions will also be evaluated. Clinical, laboratory and treatment related information will be prospectively collected in conjunction with pre scheduled PRO assessments. Cox regression analyses will be used to assess the prognostic value of baseline fatigue severity (EORTC QLQ-C30) and other patient-reported health-related quality of life parameters. DISCUSSION Clinical decision-making in RRMM is a challenge and outcome prediction is also an important aspect to enhance personalized treatment planning. Given the paucity of PRO data in this population, this prospective observational study aims to provide novel information that may facilitate patients' management in routine practice. TRIAL REGISTRATION This trial is registered as identifier NCT03190525 .
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Affiliation(s)
- Fabio Efficace
- Health Outcomes Research Unit, Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA), GIMEMA Data Center and Health Outcomes Research Unit, Via Benevento, 6, 00161, Rome, Italy.
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Maria Teresa Petrucci
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Francesco Cottone
- Health Outcomes Research Unit, Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA), GIMEMA Data Center and Health Outcomes Research Unit, Via Benevento, 6, 00161, Rome, Italy
| | - Laura Cannella
- Health Outcomes Research Unit, Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA), GIMEMA Data Center and Health Outcomes Research Unit, Via Benevento, 6, 00161, Rome, Italy
| | - Elena Zamagni
- Seragnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Pasquale Niscola
- Haematology Unit and Pathology Department, S. Eugenio Hospital Rome, Rome, Italy
| | - Charalampia Kyriakou
- Department of Haematology, London North West and University College London Hospitals, London, UK
| | - Tommaso Caravita
- Haematology Unit and Pathology Department, S. Eugenio Hospital Rome, Rome, Italy
| | - Massimo Offidani
- Clinica di Ematologia, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Franco Mandelli
- Health Outcomes Research Unit, Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA), GIMEMA Data Center and Health Outcomes Research Unit, Via Benevento, 6, 00161, Rome, Italy
| | - Michele Cavo
- Institute of Hematology Seragnoli, DIMES, University of Bologna, Bologna, Italy
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Richardson PG, Schlossman RL, Roy AN, Panneerselvam A, Acharyya S, Sopala M, Lonial S. Patient-reported outcomes of multiple myeloma patients treated with panobinostat after ≥2 lines of therapy based on the international phase 3, randomized, double-blind, placebo-controlled PANORAMA-1 trial. Br J Haematol 2018; 181:628-636. [DOI: 10.1111/bjh.15248] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/04/2017] [Indexed: 11/26/2022]
Affiliation(s)
| | - Robert L. Schlossman
- Jerome Lipper Multiple Myeloma Center; Dana-Farber Cancer Institute; Boston MA USA
| | | | | | | | | | - Sagar Lonial
- Winship Cancer Institute; Emory University School of Medicine; Atlanta GA USA
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Leleu X, Masszi T, Bahlis NJ, Viterbo L, Baker B, Gimsing P, Maisnar V, Samoilova O, Rosiñol L, Langer C, Song K, Izumi T, Cleeland C, Berg D, Lin HM, Zhu Y, Skacel T, Moreau P, Richardson PG. Patient-reported health-related quality of life from the phase III TOURMALINE-MM1 study of ixazomib-lenalidomide-dexamethasone versus placebo-lenalidomide-dexamethasone in relapsed/refractory multiple myeloma. Am J Hematol 2018; 93:985-993. [PMID: 29726031 DOI: 10.1002/ajh.25134] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/29/2018] [Accepted: 04/30/2018] [Indexed: 11/12/2022]
Abstract
TOURMALINE-MM1 is a phase III, randomized, double-blind, placebo-controlled study of ixazomib plus lenalidomide and dexamethasone (IRd) versus placebo-Rd in patients with relapsed/refractory multiple myeloma following 1-3 prior lines of therapy. The study met its primary endpoint, demonstrating significantly longer progression-free survival (PFS) in the IRd arm versus placebo-Rd arm (median 20.6 vs 14.7 months, hazard ratio 0.74, P = .01), with limited additional toxicity. Patient-reported health-related quality of life (HRQoL) was a secondary endpoint of TOURMALINE-MM1. The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core-30 (QLQ-C30) and Multiple Myeloma Module 20 (QLQ-MY20) were completed at screening, the start of cycles 1 and 2, every other cycle, the end of treatment, and every 4 weeks until progression. Over median follow-up of 23.3 and 22.9 months in the IRd and placebo-Rd arms, mean QLQ-C30 global health status (GHS)/QoL scores were maintained from baseline over the course of treatment in both groups, with no statistically significant differences between groups. EORTC QLQ-C30 function domain scores were also generally maintained from baseline; similarly, physical, emotional, and social function domains were maintained with IRd versus placebo-Rd, with slightly higher mean change from baseline scores at earlier time points with IRd. Findings from this double-blind study demonstrate that addition of ixazomib to Rd significantly improved efficacy while HRQoL was maintained, reflecting the limited additional toxicity seen with IRd versus placebo-Rd, and support the feasibility of long-term IRd administration.
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Affiliation(s)
- Xavier Leleu
- Department of Haematology, Hospital La Milétrie, and INSERM CIC 1402, Poitiers, France
| | - Tamas Masszi
- Department of Hematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Nizar J Bahlis
- Southern Alberta Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Luisa Viterbo
- Serviço de Onco-Hematologia, Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial (IPOPFG, EPE), Porto, Portugal
| | - Bartrum Baker
- Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu, New Zealand
| | - Peter Gimsing
- Department of Hematology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Vladimir Maisnar
- 4th Department of Medicine - Hematology, University Hospital, Hradec Kralove, Czech Republic
| | - Olga Samoilova
- Nizhnii Novgorod Region Clinical Hospital, Nizhnii Novgorod, Russia
| | - Laura Rosiñol
- Department of Hematology, University of Barcelona, Barcelona, Spain
| | - Christian Langer
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Kevin Song
- Division of Hematology, University of British Columbia, Vancouver, Canada
| | - Tohru Izumi
- Department of Hematology, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Charles Cleeland
- Department of Symptom Research, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Deborah Berg
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Huamao Mark Lin
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Yanyan Zhu
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Tomas Skacel
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
- Department of Hematology, Charles University General Hospital, Prague, Czech Republic
| | - Philippe Moreau
- Department of Hematology, University Hospital Hôtel Dieu, Nantes, France
| | - Paul G Richardson
- Department of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Health-Related Quality of Life after Autologous Stem Cell Transplantation for Multiple Myeloma. Biol Blood Marrow Transplant 2018; 24:1546-1553. [PMID: 29626515 DOI: 10.1016/j.bbmt.2018.03.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/29/2018] [Indexed: 01/10/2023]
Abstract
Autologous stem cell transplantation (ASCT) is an integral part of the frontline therapy in eligible multiple myeloma (MM) patients. The impact of ASCT on health-related quality of life (HRQoL) in myeloma has not been well described. We performed a systematic literature search to identify studies evaluating the impact of ASCT on HRQoL. Our search retrieved 12 relevant studies: 10 manuscripts and 2 conference abstracts. There was a widespread heterogeneity across studies in instruments used to measure HRQoL, time points of measurement, and statistical analysis. Only 1 study was a randomized controlled trial with HRQoL as a prespecified secondary endpoint. The common theme that emerged from most studies is that ASCT leads to an immediate deterioration in HRQoL and increase in symptom burden. However, baseline HRQoL and symptom scores are regained as early as 1 to 2 months post-transplantation. Furthermore, an improvement in HRQoL and pain on long-term follow-up was noted in some studies. We describe opportunities for further research in this area, including routine incorporation of HRQoL as an endpoint in transplant-related clinical trials and need for trials investigating interventions that may improve short and long-term HRQoL in myeloma ASCT recipients.
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Niscola P, Tendas A, Efficace F. Early Palliative Care in Patients With Hematological Malignancies: Where Do We Go From Here? J Pain Symptom Manage 2018; 55:e1-e2. [PMID: 29191722 DOI: 10.1016/j.jpainsymman.2017.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
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Patient-reported outcomes in relapsed/refractory multiple myeloma: a systematic review. Support Care Cancer 2018; 26:2075-2090. [PMID: 29560502 DOI: 10.1007/s00520-018-4137-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 03/02/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE We performed a systematic review to quantify the amount of evidence-based data available on patient-reported outcomes (PRO) in Relapsed/Refractory Multiple Myeloma (RRMM) patients and to examine the added value of such studies in supporting clinical decision-making. METHODS We conducted a search in PubMed/Medline and the Cochrane Library to identify studies published between January 1990 and May 2017. All studies, regardless of the design, including patients with RRMM and also evaluating PRO were considered. For each study, we collected both PRO and traditional clinical outcomes, such as survival and toxicity information, based on a predefined data extraction form. RESULTS After having screened 1680 records, 11 studies were identified and these included six randomized controlled trials (RCT). Overall, there were five studies focusing on proteasome inhibitors (PIs), four on immunomodulatory drugs (IMiDs), one on both PIs and IMiDs, and one on monoclonal antibodies. Considering only RCTs, it was found that primary clinical efficacy endpoints frequently favored experimental arms, while (physician-reported) toxicity data did not. However, inspection of PRO data revealed novel information that often contrasted with standard toxicity, for example, by not indicating worse quality of life outcomes or symptom severity for patients enrolled in the experimental arms. CONCLUSIONS There is paucity of evidence-based data regarding the impact of therapies on quality of life and symptom burden of patients with RRMM. Inclusion of PRO in future studies of patients with RRMM is needed to better inform clinical decision-making.
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Blade J, Calleja MÁ, Lahuerta JJ, Poveda JL, de Paz HD, Lizán L. Defining a set of standardised outcome measures for newly diagnosed patients with multiple myeloma using the Delphi consensus method: the IMPORTA project. BMJ Open 2018; 8:e018850. [PMID: 29472263 PMCID: PMC5855445 DOI: 10.1136/bmjopen-2017-018850] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To define a standard set of outcomes and the most appropriate instruments to measure them for managing newly diagnosed patients with multiple myeloma (MM). METHODS A literature review and five discussion groups facilitated the design of two-round Delphi questionnaire. Delphi panellists (haematologists, hospital pharmacists and patients) were identified by the scientific committee, the Spanish Program of Haematology Treatments Foundation, the Spanish Society of Hospital Pharmacies and the Spanish Community of Patients with MM. Panellist's perception about outcomes' suitability and feasibility of use was assessed on a seven-point Likert scale. Consensus was reached when at least 75% of the respondents reached agreement or disagreement. A scientific committee led the project. RESULTS Fifty-one and 45 panellists participated in the first and second Delphi rounds, respectively. Consensus was reached to use overall survival, progression-free survival, minimal residual disease and treatment response to assess survival and disease control. Panellists agreed to measure health-related quality of life, pain, performance status, fatigue, psychosocial status, symptoms, self-perception on body image, sexuality and preferences/satisfaction. However, panellist did not reach consensus about the feasibility of assessing in routine practice psychosocial status, symptoms, self-perception on body image and sexuality. Consensus was reached to collect patient-reported outcomes through the European Organisation for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) Core questionnaire 30 (C30), three items from EORTC-QLQ-Multiple Myeloma (MY20) and EORTC-QLQ-Breast Cancer (BR23), pain Visual Analogue Scale, Morisky-Green and ad hoc questions about patients' preferences/satisfaction. CONCLUSIONS A consensual standard set of outcomes for managing newly diagnosed patients with MM has been defined. The feasibility of its implementation in routine practice will be assessed in a future pilot study.
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Affiliation(s)
- Joan Blade
- Hematology Department, Hospital Clinic, Institut d’Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | | | | - José Luis Poveda
- Pharmacy Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Luis Lizán
- Outcomes'10, Castellon, Spain
- Medicine Department, University Jaume I, Castellón, Spain
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