Quality of Life in High-Risk Myeloma Patients Treated with Allogeneic Hematopoietic Cell Transplantation Followed by Bortezomib Maintenance

Abstract

Purpose. Allogeneic hematopoietic cell transplantation (HCT) is the only curative treatment in multiple myeloma (MM) but is associated with toxicities that impact quality of life (QoL). This study aimed (1) to describe the levels and evolution of QoL scores of newly diagnosed MM patients who received upfront tandem autologous + nonmyeloablative allogeneic HCT, and (2) to evaluate the impact of chronic graft-versus-host disease (cGVHD) on QoL. Methods. After induction and autologous HCT, patients were invited to participate in a prospective phase II study of tandem nonmyeloablative allogeneic HCT followed by bortezomib maintenance for one year. Participants completed questionnaires assessing QoL and cGVHD before allogeneic HCT (T1), then every three months during treatment (T2 to T6) and after treatment cessation (T7 to T10). Results. Thirty-three patients were included. Participants had high levels of QoL at all measurement times. Cognitive functioning and global health status decreased significantly during treatment (T1 vs. T2-T5), while fatigue symptoms were reported more frequently. After treatment cessation (T7-T10), only cognitive functioning remained significantly impacted. In contrast, participants reported a better emotional well-being after transplant (T1 vs. T2, T4-T10). Furthermore, as QoL scores were more frequently associated to lung, energy and psychological cGVHD domains. Conclusion. Our study demonstrates preservation of QoL during this upfront tandem treatment including autologous transplant followed by allogeneic HCT. Some identified domains impacting QoL may support therapeutic actions such as supportive care including psychological and neuropsychological interventions, as well as adapted physical activity in this population. This trial was registered on 01/12/2014 to ClinicalTrial.gov: NCT02308280.