Life In Multiple Myeloma Patients Research Articles

Recent Updates in the Diagnosis and Management of Kidney Diseases in Multiple Myeloma

Multiple myeloma (MM) represents a difficult-to-treat plasma cell malignancy and the second most common hematologic malignancy in adults, significantly impacting kidney function. The spectrum of kidney involvement in MM is broad, encompassing electrolyte imbalances, tubular injury, and even rare glomerular diseases. The evolution of MM treatment modalities has led to notable improvements in the long-term survival of patients experiencing kidney-related complications. Over the past decade, groundbreaking therapeutic agents have emerged, including proteasome inhibitors, immunomodulatory drugs, anti-CD38 monoclonal antibodies, selective inhibitors of nuclear export, and antibody-drug conjugates. These novel therapies have revolutionized the landscape of MM management, offering new hope for patients and challenging the traditional treatment paradigms. This comprehensive review explores recent advances in the diagnosis and management of MM, emphasizing the pivotal role of these innovative therapeutic agents in improving patient outcomes. We delve into the intricacies of diagnosing MM, highlighting the significance of early detection and precise diagnostic tools. We elucidate the evolving treatment strategies, emphasizing the mechanisms of action and clinical efficacy of the latest agents. This manuscript provides valuable insights into the ever-evolving field of MM management, shedding light on the remarkable progress achieved in enhancing the prognosis and quality of life of MM patients.

Harnessing Nanotechnology: Emerging Strategies for Multiple Myeloma Therapy.

Advances in nanotechnology have provided novel avenues for the diagnosis and treatment of multiple myeloma (MM), a hematological malignancy characterized by the clonal proliferation of plasma cells in the bone marrow. This review elucidates the potential of nanotechnology to revolutionize myeloma therapy, focusing on nanoparticle-based drug delivery systems, nanoscale imaging techniques, and nano-immunotherapy. Nanoparticle-based drug delivery systems offer enhanced drug targeting, reduced systemic toxicity, and improved therapeutic efficacy. We discuss the latest developments in nanocarriers, such as liposomes, polymeric nanoparticles, and inorganic nanoparticles, used for the delivery of chemotherapeutic agents, siRNA, and miRNA in MM treatment. We delve into nanoscale imaging techniques which provide spatial multi-omic data, offering a holistic view of the tumor microenvironment. This spatial resolution can help decipher the complex interplay between cancer cells and their surrounding environment, facilitating the development of highly targeted therapies. Lastly, we explore the burgeoning field of nano-immunotherapy, which employs nanoparticles to modulate the immune system for myeloma treatment. Specifically, we consider how nanoparticles can be used to deliver tumor antigens to antigen-presenting cells, thus enhancing the body's immune response against myeloma cells. In conclusion, nanotechnology holds great promise for improving the prognosis and quality of life of MM patients. However, several challenges remain, including the need for further preclinical and clinical trials to assess the safety and efficacy of these emerging strategies. Future research should also focus on developing personalized nanomedicine approaches, which could tailor treatments to individual patients based on their genetic and molecular profiles.

Age-Based Comparison of Dara-Rvd, Krd and Rvd Induction Therapies during the First Line of Therapy for Multiple Myeloma Patients

Background Since the development of proteasome inhibitors, the combination of lenalidomide (R), bortezomib (V), and dexamethasone (d) for induction has been the standard of care when treating patients with multiple myeloma. This combination has been shown to improve the clinical outcomes and quality of life of multiple myeloma patients. More recently, new generations of proteasome inhibitors, such as carfilzomib (K), and the development of monoclonal antibodies have created new opportunities for treatment that provide better outcomes with fewer side effects. The addition of daratumumab (Dara) to the RVd induction therapy has shown more potent results, increasing response rates and outcomes. However, there is a lack of evidence about the influence that age may have on the efficacy of these therapies. Methodology Using HealthTree Cure Hub for Multiple Myeloma (PMID: 35271305), we analyzed real-world data from 1100 patients with multiple myeloma. Patients were categorized into two groups based on age (<65 and ≥65). We compared ‘Time to Next Treatment’ (TTNT) among patients who received DaraRVd, KRd, or RVd as induction therapy. The analysis was conducted using Kaplan-Meier curves in R. Age groups were also subclassified by high-risk cytogenetics according to mSMART staging by fluorescence in situ hybridization (FISH), and the Revised International Staging System (R-ISS) stage. Chi-square tests were used to assess the association with R-ISS and mSMART stages. Results We analyzed the data of 1100 patients with MM, of which 718 patients (65.3%) were age <65 and 382 patients (34.7%) were age ≥65. The <65 group had a median age of 55±7, and the ≥65 group had a median age of 70±5. The majority of patients were female (n=586, 53.3%). The median year of diagnosis was 2018 (2009-2022). In the <65 group, the majority of patients were White (88%), and other big groups were Blacks (5.8%), and Hispanics or Latinos (2.6%). Similarly, in the ≥65 group, the majority of patients were White (93.0%), and other big groups were Blacks (3.3%), and Hispanics or Latinos (2%). In the <65 group, 55 patients had DRVd as induction therapy, 77 KRd, and 586 RVd. In the ≥65 group, 38 patients received DRVd as induction therapy, 39 KRd, and 305 RVd. R-ISS staging was available for 588 patients. In the <65 group, 139 patients (36.7%) were classified as R-ISS stage I, 170 patients (44.8%) stage II, and 70 patients (18.5%) stage III. In the ≥65 group, 75 patients (35.9%) were stage I, 104 patients (49.8%) were stage II, and 30 patients (14.3%) were stage III ( p=0.37). mSMART staging was available for 1035 patients, of whom patients with high-risk, double, and triple hit represented 16.2%, 5.0%, and 0.3%, respectively ( p = 0.35). Regarding stem cell transplant (SCT), 571 patients (51.9%) underwent SCT. In the <65 group, 404 patients (56.3%) received SCT; of those, 18 (32.7%) received DRVd, 21 (53.3%) KRd, and 345 (58.9%) RVd. In the ≥65 group, 167 patients (43.7%) received SCT; of those, 12 (31.6%) received DRVd, 23 (59%) KRd, and 132 (43.3%) RVd as induction therapy. For patients aged <65, the median TTNT was not yet reached for the DRVd group, 33 mo for the KRd group, and the RVd group was longer at 48 mo ( p=0.049). For patients aged ≥65, the median TTNT was not yet reached for the DRVd group, and 54 mo for the KRd group, which did not significantly differ from the RVd group, which had a median TTNT of 47 mo (p=0.52). Conclusion This study found that in the <65 age group, RVd induction therapy led to a longer TTNT compared to KRd, while in the ≥65 age group, KRd showed a longer TTNT than RVd. When considering the SCT usage rate, which increases TTNT by at least 12 months on average, KRd did not significantly improve outcomes over RVd in both age groups. However, when evaluating KRd induction, it's worth noting that KRd showed an improved outcome with a longer TTNT in the ≥65 age group compared to the <65 age group, despite toxicity concerns. These results align with the ENDURANCE trial, which also indicated that KRd did not significantly improve outcomes in standard-risk patients compared to VRd. Though the TTNT for the DRVd group is yet to be reached, the current trend suggests promising results for DRVd as a first-line therapy over KRd and RVd in both age groups. Nevertheless, further research is needed to validate and gain better insight into these observed trends.

Taste Abnormalities Emerging during Anti-Myeloma Therapies Including GPRC5D x CD3 Bispecific Antibody Talquetamab

Background: Dysgeusia is a common, yet underexamined side-effect of anti-tumor therapy. In multiple myeloma (MM) it has received more attention recently with the introduction of talquetamab, a bispecific T-cell engaging antibody targeting GPRC5D. Although GPRC5D expression is mainly restricted to plasma cells, cornified tissues including some cells in the oral cavity also express GPRC5D. This expression could be associated with changes in taste perception in patients undergoing therapy with talquetamab. Abnormalities in taste perception can negatively affect patients' quality of life and nutritional status, and in some cases may even require treatment interruption with a potential negative impact on outcome. Our objective was to determine the quality and severity of dysgeusia and its impact on quality of life in MM patients treated with talquetamab. To take our findings into perspective, we compared these results to patients who received high-dose melphalan, a treatment which goes along with taste abnormalities frequently (positive controls) as well as with BCMA targeting bispecific antibodies for which taste abnormalities have not been reported thus far (negative controls). Methods: We used a validated diagnostic instrument, “Taste-Strips”, to objectively assess gustatory performance in all five qualities of taste (sour, sweet, bitter, salty and umami). Further, we used a validated diagnostic instrument, “Sniffin' Sticks Identification Test 16”, to identify possible changes in olfactory perception. In addition, we used a questionnaire to document subjectively perceived changes in taste perception, oropharyngeal symptoms, nutritional status, individual diet-related symptoms, therapy compliance and quality of life. Results: We enrolled 55 patients with MM in our study. Seven (13%) patients were treated with a GPRC5D bispecific. Twenty-one (38%) patients received a BCMA bispecific and 27 (49%) patients received melphalan. All patients receiving a GPRC5D bispecific responded to treatment but also reported a significantly impaired overall taste sensation. They were significantly more likely to report loss of appetite ( P<0.01; Fisher test), loss of bodyweight (GPRC5D bispecifics: -4.3kg (SD4.6); BCMA bispecifics: -0.3kg (SD2.0); melphalan: -2.8kg (SD2.8)) and dry mouth ( P<0.01; Fisher test). Futhermore, patients receiving a GPRC5D bispecific reported a severe to very severe subjectively perceived level of impairment in quality of life due to subjectively perceived changes in gustatory perception of sweet, bitter, umami, and salty flavors (in descending order; P<0.01; Fisher test) and dry mouth ( P<0.01; Fisher test) than patients receiving BCMA bispecifics or melphalan. Forty-eight% of patients on BCMA bispecifics and 59% of patients on melphalan reported some level of dysguesia, which was objectified by “Taste-strips”-testing, highlighting the overall underreported frequency of this side effect. Of note, melphalan patients reported nausea and vomiting significantly more frequently than the other groups ( P<0.01; Fisher test). Objective olfactory testing did not show significant differences in olfactory perception between patients who received GPRC5D bispecifics, BCMA bispecifics or melphalan. Conclusion: Our results demonstrate the importance of monitoring taste perception and quality of life changes caused by cancer therapies. The frequency of dysgeusia is underreported in MM patients receiving BCMA bispecifics and melphalan therapy. For optimal nutritional management, hospitals should consider patients' individual taste preferences.

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).

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. 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. 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. 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.

Use of Myeloma Patient Outcome Scale (MyPOS) to gauge the effectiveness of palliative management in patients with multiple myeloma: Experience from a large tertiary academic center in India.

e24137 Background: A diagnosis of Multiple Myeloma (MM) can carry significant physical, social, functional and emotional repercussions. There is a lack of data on Baseline Quality of Life (QOL) in patients with MM and effectiveness of palliative management in the Indian context, especially after the advent of newer chemo-immunotherapeutic agents and autologous stem cell transplant (ASCT). Myeloma Patient Outcome Scale (MyPOS) is the first questionnaire developed specific for MM patients. Objectives and Methods: To evaluate symptom burden and quality of life in MM patients admitted to the medical oncology ward. To assess change in quality of life and symptoms as well as analgesic requirements on telephonic follow up after one and three months from index admission. After institutional ethical clearance, MM inpatients were prospectively enrolled. Clinical and treatment related details were recorded. MyPOS questionnaire was administered as well as a detailed pain assessment using Brief Pain Inventory (BPI) was carried out at baseline, 1 and 3 months. Results: 82 out of 100 MM patients consented for recruitment (Mean age- 52 +/- 9yrs; Male- 55%). Mean duration of the disease since diagnosis was less than 1 year (0.86 years), with a mean International staging system (ISS) score of 2. Up to half (37/82, 45%) of the patients received ASCT in addition to chemotherapy. The baseline Global MyPOS Score was 58 +/- 8.8 while the mean Pain severity (MPS) and interference (MPI) scores were 25+/-8 and 43+/-10 respectively. The most painful region was the back. Only Tramadol was sufficient for a small minority (6/82, 7.4%), most required oral morphine. Most patents had significant interval improvement in their pain and QOL scores with a p less than 0.01 on follow-up (MyPOS at 1 month and 3 month were 81+/-6 and 78+/-5, MPS were 21+/-13 and 17+/-1.1, MPI were 38+/-2.2 and 37+/-2.1 respectively). Conclusions: Adequate pain management can significantly improve quality of life in MM patients. Use of standardized questionnaires such as MyPOS is a quintessential tool for the palliative specialist in order to gauge therapeutic efficacy.

Abstract 6498: Association of lifestyle related risk factors with multiple myeloma mortality rates in the United States

Abstract Background: The prognosis for multiple myeloma (MM) has significantly improved over the years. Lifestyle risk factor modifications have improved the quality of life in MM patients, however, their effect on the survival outcomes in these patients remains unknown. Methods: We extracted data on age-adjusted mortality rate (AAMR) rates of MM (per 100,000 population) for all 50 U.S. states and the District of Columbia from the Center for Disease Control (CDC) WONDER database (2015-2019). Data on risk factors such as obesity, physical activity, alcohol, tobacco abuse, and nutrition were obtained from the Behavioral Risk Factor Surveillance System (BRFSS, 2021). Florida was excluded due to missing information. Correlations were analyzed using Pearson’s coefficient. Statistical analysis was performed using VassarStats. Results: Median AAMR of MM in the US was 3.2 (IQR 2.7, 3.7) per 100,000 population. States with higher age-adjusted prevalence (AAP) percentages of obesity had higher AAMR (r=0.39, p=0.004) of MM. This association was significant in non-Hispanic white (r=0.32, p=0.021), and non-Hispanic black (r=0.31, p=0.034) subgroups as well. States with a higher AAP of adherence to recommended weekly aerobic activity had lower AAMR (r=-0.37, p=0.007). We did not identify any correlation of AAMR with AAP of binge drinking (r=-0.036, p=0.803), consumption of fruits (r=0.04, p=0.75), vegetables (r=-0.133, p=0.357), and smoking history (r=0.052, p=0.72). Conclusions: In the current analysis, a higher prevalence of obesity and lower rates of aerobic physical activity were strongly associated with increased AAMR of MM. Our results, therefore, underscore the need for emphasis on a holistic approach in the management of MM by including lifestyle-based risk factor modification, to further improve the survival outcomes in patients with MM. Citation Format: Shiva Jashwanth Gaddam, Udhayvir Singh Grewal, Himaja Kumari Avvaru, Poornima Ramadas. Association of lifestyle related risk factors with multiple myeloma mortality rates in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6498.

Clinicopathological Spectrum of Multiple Myeloma: Experience of an Institute in Eastern India

Introduction: Multiple myeloma (MM) is a neoplastic plasma cell disorder characterized by clonal proliferation of malignant plasma cells in the bone marrow. Incidence of MM is increasing rapidly in Asian countries. In a developing country like India diagnosis, risk stratification and access to novel treatment is still a major hurdle Objective: To study the clinico-pathological features of newly diagnosed multiple myeloma patients. Methods: This was a cross sectional hospital based retrospective study conducted in a hospital in eastern India. During the four years of study, 74 cases of multiple myeloma were diagnosed on the basis of International Myeloma Working Group: Criteria for the classification of multiple myeloma and related disorders. The clinical and laboratory characteristics of newly diagnosed patients were studied. Results: Out of the 74 patients, 69% were men and 31% were women. Median age at diagnosis was 55 years (range: 32-81 years). The commonest symptoms observed were fatigue and bone pain. Anemia was present initially in 81% of patients, hypercalcemia in 31.4%, and a serum creatinine level of 2 mg/dL or more in 24.6% patients. The most common monoclonal gammopathy was IgG kappa (44%). Diffuse pattern of bone marrow infiltration, the most common pattern observed in 59% patients. Conclusion: MM patients had male preponderance. Median age of patients was lower compared to western countries with higher percentage of patients with age less than 40 years. Quality of life in MM patients can be improved significantly if there is access to early diagnosis, risk stratification and novel treatment.

Improving Quality of Life and Treatment Adherence in Multiple Myeloma Patients Using Education Strategies Based on Digital and Spaced Learning

Multiple myeloma is the second most frequent hematological malignancy in the world. It is characterized by bony destruction, anemia, worsening renal function, and immune system compromise, which makes it an aggressive and limiting disease with high morbidity and mortality. To optimize outcomes and patients' quality of life it is necessary to achieve adequate control of the disease by improving adherence to treatment and reinforcing patient education. The objective of our study is to measure the impact of a new education strategy based on digital, personalized, spaced-learning, on treatment adherence, adverse effects prevention, and quality of life of multiple myeloma patients. We designed a randomized double-blind trial with two groups, one who received the study intervention (IG) and one control group (CG). Both groups received standard education from the medical and nursing staff, and the intervention group additionally received an education based on a sequential strategy that aimed for a better understanding of the disease's nature, treatment adherence, lifestyle changes, identifying and treating symptoms, preventing side effects, and making the decisions towards the end of life. We completed four monthly sessions directed to patients and caregivers, and we pursued a fifth session after the sixth cycle of treatment in patients who were not transplant candidates or upon maintenance initiation for transplanted patients, during a total period of six and eight months for non-transplanted and transplanted patients respectively. These sessions were conducted using an interactive virtual platform with personalized conferences, text messages, and end-of-session evaluations to assess the understanding of the information shared. To measure the adherence to treatment following our intervention we used the treatment adherence scale MAQ (Medication Adherence Questionnaire) and we estimated the proportion of attended clinic visits for chemotherapy infusions. To evaluate the incidence of adverse effects, we measured the presence of infections, anemia, renal failure, hypercalcemia, peripheral neuropathy, and pain on diagnosis and during our follow-up period. To assess patients' quality of life we used a multiple myeloma-specific scale known as EORT QLQ-C30+QLQ-MY20. This scale evaluates 5 domains: general state of health, general functionality, general symptoms, myeloma-specific symptoms, and myeloma-specific functionality, ranging of 0-100, where a higher number is better for functionality and state of health domains, and worst for symptoms domain. The statistical analysis was performed using IBM SPSS version 25 software. A total of 32 patients with multiple myeloma were included at the moment of their diagnosis, 16 in each arm. All patients were treated with a chemotherapy regimen based on proteasome inhibitors and immunomodulatory drugs, 56.25% (n=18) of the patients were transplant-eligible, from them 10 patients were in intervention group. There were no significant differences in the demographic or clinic characteristics, nor in the rate of side effects at baseline between the two groups. After the fifth session evaluation, we observed a significant improvement in the C30 Qol test of the patients in the intervention arm compared to the control group (IG from 61.4 to 74.9 vs GC from 77.6 to 52.6, p=0.02), as well as their cancer-specific functionality (C30 functional) level (IG from 58.4 to 74.9 vs CG from 75.1 to 52.4, p=0.02) and in their myeloma-specific functionality (MY20 functional) the IG hold the mean score and CG show a decrease in mean score (IG from 68.2 to 64.5 vs CG from 72.3 to 46.9, p=0.06). A significantly higher difference in adherence to treatment was noted in the intervention group vs the control group (IG 93%, n=15 vs CG 18.8%, n=3, p<0.001). We did not find statistically significant differences in the adverse effect rate among the two groups. In conclusion, it is important that multiple myeloma care programs develop education strategies for patients and their caregivers that allow understanding of the disease, treatment options, lifestyle changes choices, and prognosis, by using spaced, personalized, virtual-based, interactive learning that enhances memory, commitment to tasks and healthy choices, which will empower patients and caregivers and will translate into improved adherence to treatment, better quality of life and functionality. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Health-related quality of life of multiple myeloma patients after the first-line treatment: results of a prospective cohort study

Objective: The aim of this study was to evaluate whether there was an improvement or a deterioration of health-related quality of life (HRQoL) of multiple myeloma patients (MM), and to assess the associated factors with HRQoL after 12 months of treatment. Methods: We performed a prospective cohort study with MM patients in first-line treatment from public and private onco-hematology health services in a Brazilian metropolis. HRQoL, socio-demographic and clinical variables were obtained by interviews and review of medical charts. HRQoL and peripheral neuropathy (PN) were collected through validated instruments (QLQ-C30, QLQ-MY20, CINQ). Medians of the HRQoL scores, obtained at baseline and follow-up interviews, were compared. Median HRQOL scores at follow-up were compared by variables. The improvement or deterioration in HRQoL and the association with variables were measured. Results: Thirty-three patients completed the follow-up, with ISS III (25.0 %), on polypharmacy (72.2 %), using a thalidomide+bortezomib-based regimen as first-line (19.4 %), and median age of 66.5 years. HRQoL Summary score, Functioning, Symptom scales, and Future Perspective scores were improved between periods (p&lt;0.05). Patients who were on polypharmacy, with severe PN, and with ISS III had deterioration in HRQoL; younger patients had improvement and older patients had deterioration in HRQoL (p&lt;0.05). Conclusions: Our study showed that first-line treatment improved HRQoL of patients in the following QLQ-C30 scales: Summary score, Role functioning, Emotional functioning, Fatigue, Pain, and Constipation; and in QLQ-MY20, Future perspective was improved. Our study shows the importance of using patient-reported outcomes during MM treatment.

The Influence of Cannabinoids on Multiple Myeloma Cells: A Scoping Review

Multiple myeloma (MM) is one of the most common hematological malignancies. There is a clear need for research into new treatment options that can improve the life expectancy and quality of life for MM patients; this is particularly salient for those with relapsed/refractory disease. Cannabinoids (CB) have shown potential in treatment regimens for a number of cancers, but little is currently known about their effectiveness against MM. Hence, we conducted a scoping review regarding the usage of CB against MM cells. For our review, searches were conducted in PubMed, Web of Science, and OVID Medline. After screening, six articles were eligible for inclusion, all of which were laboratory studies. It was demonstrated that CB decrease MM cell viability, and this was consistently shown to occur alongside the activation of apoptotic pathways in MM cells. These effects were shown to continue to occur in dexamethasone-resistant MM cells. The effects of CB on MM cells were enhanced when used in combination with standard treatments for MM. Critically, these marked decreases in MM cell viability induced by CB did not occur in non-MM cells. Overall, these findings indicate a clear need for future clinical trials of the integration of CB into MM treatment regimens.

Curcumin for Quality of Life of Multiple Myeloma Patients: a Randomized, Placebo-Controlled Trial

Background : The main goal of multiple myeloma (MM) therapy is to control the disease, prolong the survival, and improve the life quality. Curcumin affects pro-inflammatory cytokines. There is no research yet that has been conducted to evaluate the effects of curcumin on increasing MM patient's life quality. Objective of this study is to evaluate the effect of curcumin on increasing MM patients' life quality. Methods : Of 24 MM patients were enrolled and were divided randomly into treatment groups (n=12) and controls (n=12). Patients in treatment group received melphalan 4 mg/m2, prednisone 40 mg/m2 (MP) for 7 days and curcumin 8 grams/day for 28 days. The control group received MP and placebo. Quality of life (QoL) scores were measured in early diagnosis and after 4 cycles of treatment. The difference between two groups was analyzed using Mann-Whitney U-Test or Independent T Test. Results : The role function score of the treatment group was better than control. There is a significant difference function score of patients between the treatment and control group, at baseline and 4 cycles treatment (41.66 ± 3.85 vs. 23.61 ± 3.36; 95.83 ± 1.03 vs 76.39 ± 2.51; p=0.022). There was significantly different of insomnia score between treatment and control goup at baseline and the end 4 cycles (41.67 ± 3.79 vs 58.33 ± 3.51; 9.72 ± 1.5 vs 25 ± 1.32; p=0.02). Conclusion : The addition of curcumin in myeloma patients enhances the QoL score, role function score and lowered symptom insomnia.

REAL WORLD MULTIPLE MYELOMA REGISTRY FROM JORDAN, A DEVELOPING COUNTRY.

Background and objectiveScanty reports from the middle east and north Africa (MENA) region have been published on multiple myeloma (MM). Multiple myeloma registry has been established at Jordan University Hospital (JUH) since 2009. Our work aims to review this Multiple Myeloma registry with data from 113 patients diagnosed with MM at JUH and analyze their management and course.MethodsThis is a non-interventional and retrospective analysis of the MM registry from 2009-to 2016 involving 113 patients at JUH. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS). Overall survival (OS) was analyzed with the Kaplan-Meier method. P-value was considered significant if it was (<0.05).ResultsWe found no gender difference in this registry. The median age is 62 years. Most patients are in ISS stage II and III (36.28% for each). Immunoglobulin type G Kappa is the dominant subtype. Bone pain is the most common presenting symptom. The most common laboratory finding is anemia (45.6%). Most of our patients (85.2%) had received thalidomide and dexamethasone, while only 14.8% received bortezomib, thalidomide, and dexamethasone. Our patients' mean overall survival (OS) was 74 months, and the median survival was 38 months. For ISS stages I, II, and III, median OS was 96, 46, and 16 months.ConclusionMM in a developing country presents a challenging disease compared to industrial countries in both epidemiology and management. An improved road map in the care of MM in these countries is needed. The use of three or four drugs combination upfront is warranted. However, this is limited because of the high cost of these drugs. We expect the following decade to show better survival and quality of life for MM patients once these drugs are widely used.

POSC374 Association of COVID-19 on Adherence to Oral Specialty Pharmacy Oncology Medications and Quality of Life of Multiple Myeloma Patients

In winter of 2019-2021 SARS-CoV-2 became pandemic (CoVID-19 or P). During P, treating patients with chronic disease burden, i.e., cancer (O), with multiple myeloma (MM) oncologics and achieving high medication adherence was reported to be challenging, e.g., delayed/missed provider visits, prescriptions, lab tests, and P-related financial difficulties and feelings of depression or anxiety. There are two Objectives: that characterize how the P may be associated with changes in: 1. adherence to specialty pharmacy MM medications (O-SP-D) and 2.

Early and late relapses of multiple myeloma after autologous haematopoietic stem cell transplantation

Introduction. Autologous haematopoietic stem cell transplantation (auto-HSCT) is a highly effective treatment for multiple myeloma (MM). Auto-HSCT allows a signifi cant improvement of haematological response leading to higher overall survival and quality of life in MM patients. Nonetheless, the majority of patients develop relapse.Aim — a comparison of clinical MM relapses developing at variant terms after auto-HSCT.Patients and methods. A retrospective study enrolled 65 MM patients aged between 39 and 64 years. All patients had auto-HSCT during 2009–2019, all had achieved complete response (CR) or very good partial response (VGPR) and all since developed immunochemical MM relapse in laboratory evidence. Patients were divided in two cohorts by relapse term, the early (within 12 months of auto-HSCT) and late relapse.Results. Early immunochemical relapse was diagnosed in 13 (20 %), late relapse — in 52 (80 %) patients. The dependence between relapse term and depth of post-auto-HSCT antitumour response has been determined. The proportion of CR patients was signifi cantly higher in late than in early relapse (55.8 vs. 23 %). In follow-up, 60 patients (92.3 %) were initiated on antirelapse therapy, all early relapse and 90.3 % late relapse patients. On day +100 of auto-HSCT, CR patients had later relapse vs. VGPR individuals (median 24 vs. 19.9 months, p = 0.08) with signifi cantly weaker paraprotein secretion resembling the clinical course of monoclonal gammopathy of unclear signifi cance (MGUS).Conclusion. Auto-HSCT allows long-term control of the disease. A signifi cant prognostic factor is antitumour response on +100 day of auto-HSCT. Patients attaining CR have later relapse progressing in a MGUS-like manner. Patients with late indolent relapse can be managed long-term without antitumour therapy.

Effective pain control with very low dose palliative radiotherapy for multiple myeloma patients with painful osseous lesions

Osteolytic lesions are present in 75% of multiple myeloma (MM) patients. Bone pain is a common presenting symptom. Prior case series analyzing palliative radiation (RT) for bone pain in MM patients suggest doses > 12 Gy (EQD2) provide similar excellent palliation. Recent advances in novel biologic agents have significantly improved the overall survival and quality of life for MM patients. We therefore hypothesized that lower-dose palliative RT (LDRT, i.e. EQD2 < 12 Gy) may offer a safe and effective alternative to higher-dose RT (HDRT) for the treatment of bone lesions in MM patients. We retrospectively identified all MM patients treated with RT for painful bone lesions, at either a tertiary care academic center or Veterans Affairs affiliate hospital, between 2013 and 2019. All patients underwent CT simulation and were treated with standard palliative fields. Patients were grouped into the LDRT cohort if the EQD2 < 12 Gy, with all others comprising the HDRT cohort. Patients were routinely seen in follow-up after the completion of RT and assessed for pain response and toxicity per clinic standards. We analyzed the rates of clinical pain response (CPR), differences in acute and late toxicity, duration of pain response, and retreatment rates between LDRT and HDRT groups. Thirty-four patients with 70 treated lesions were included. Twenty-four patients (49 lesions) were treated with HDRT and 10 patients (21 lesions) with LDRT. Median follow up was 16.8 months (IQR = 6.5-42.9 months) among those still alive and 94% of patients went on to receive systemic therapy. Fifty percent of patients in the HDRT cohort had rISS stage 1 MM versus 20% in the LDRT cohort. The median dose of HDRT treatment was 20 Gy (range 8-30 Gy, EQD2 12-32.5 Gy) versus 4 Gy in the LDRT group (range = 4-8 Gy, EQD2 4.67-9.3 Gy). The overall CPR rate was 97%, with CPR for HDRT = 98% and LDRT = 95%. Although acute toxicity appeared greater for the HDRT cohort (24.5%) than the LDRT cohort (9.5%), this was not significant (Χ2 p = 0.15). Five lesions required retreatment, 2 (9.5%) in the LDRT cohort and 3 (6.3%) in the HDRT cohort. Of the LDRT patients, one had progression of a pre-existing pathologic fracture and the other had subsequent CPR upon reirradiation. Pain recurred in 10% of lesions (12% HDRT versus 9.5% LDRT). The median pain response durations were not yet reached and there was no significant difference between the LDRT versus HDRT cohorts (log rank p = 0.91). This analysis suggests that LDRT effectively palliates painful MM bony lesions with acceptable CPR and duration of palliation, despite differences in patient MM stage between groups. LDRT palliation could permit patients to proceed quickly to systemic therapy by minimizing treatment duration and acute side effects. These data support further prospective comparisons of LDRT versus HDRT for palliation of MM bony lesions.

B-cell maturation antigen-specific chimeric antigen receptor T cells for multiple myeloma: Clinical experience and future perspectives.

Despite major advances in the treatment of multiple myeloma (MM), it remains a largely incurable disease with long-term control often dependent on continuous therapy. More effective, better tolerated treatments are therefore required to achieve durable remissions and to improve the quality of life of MM patients. Adoptive immunotherapy employing T cells expressing chimeric antigen receptors (CAR) is currently among the most promising treatment approaches in cancer. Within the target portfolio for MM immunotherapy, B-cell maturation antigen (BCMA) is among the most widely studied target antigens. BCMA is consistently expressed on MM cells and, importantly, is not expressed in critical healthy tissue. For this reason, it is an ideal target for MM immunotherapy. Several clinical trials evaluating different BCMA-targeting CAR constructs have been initiated and early results are very promising. However, in this rapidly developing clinical landscape, the ultimate role of BCMA-specific CAR-T cell therapy remains unclear. In this review, we will summarize currently available clinical data on BCMA-directed CAR-T cells and discuss potential future perspective for this promising treatment approach in MM.

Health- Related Quality of Life for Multiple Myeloma Patients with Bone Metastases in Indonesia: A Cross-Sectional Study.

Objective:Multiple myeloma (MM) with bone metastases causes a skeletal-related event (SRE), and decreases health-related quality of life (HRQoL). HRQoL needs to be evaluated for health technology assessment (HTA). Furthermore, HRQoL is calculated as a health state utility and is used in the Markov Model for HTA. Therefore, this study aimed to describe the HRQoL of MM patients with bone metastases, using The EuroQol five-dimension five levels (EQ -5D-5L) in Indonesia. Methods:a cross-sectional, multicenter study for MM patients with bone metastases (aged over 18 years old) that consulted a physician between November 2018 - May 2019 was conducted. The calculated HRQoL illustrated the health state utility, which was assessed using the EQ-5D-5L questionnaire, with the Indonesian value set. In addition, Mann-Whitney analyses were performed to determine the difference in utility scores at different points within the Durie-Salmon staging system and skeletal condition. Results:in 93 patients who completed the questioner, pain was their major concern with prevalence of over 60% (all levels inclusive). Moreover, the mean utility of patients in stage II and III were 0.735 (SD = 0.205) and 0.383 (SD = 0.555), and those without SRE was 0.753 (SD = 0.213) while patients with SRE was 0.302 (SD = 0.562). Therefore, the lessened values were observed at stage III and SRE condition (p<0.05). Conclusion:MM patients with bone metastases have poor HRQoL, with pain as the most frequently reported challenge, which is associated with an advanced stage of MM and SRE event.

The importance of physical function in patients with multiple myeloma for improving quality of life.

To investigate the relationship between physical function and quality of life in multiple myeloma patients. In this retrospective cross-sectional study, data from patients with multiple myeloma (N = 63), who were referred to the department of Rehabilitation Medicine from October 2017 to May 2018, were reviewed. Patients were excluded based on the following criteria: acute illness, unstable medical conditions, impaired cognition or communication, refusal, or inability to perform the assessment. Physical function was evaluated with the Mini-Balance Evaluation Systems Test (Mini-BESTest), and the European Organization for Research and Treatment of Cancer questionnaires QLQ-C30 and QLQ-MY20 were used for the evaluation of quality of life. To evaluate fatigue and psychotic status, the Fatigue Severity Scale and Beck Depression Inventory were used. Patients were divided into two groups ("good-function group" and "poor-function group"), based on previously studied normative values of the Mini-BESTest. Clinical data was reviewed to interrogate the contributing factors of physical function. Positive correlations were observed between Mini-BESTest scores and all domains of the QLQ-C30. The Mini-BESTest score was lower in patients with lower serum hemoglobin (r = 0.396, p = 0.001) and albumin levels (r = 0.440, p < 0.001), severe disease-related symptoms (r = - 0.39, p = 0.02), and depression (r = - 0.538, p < 0.001). Further, the poor-function group showed lower hemoglobin (p = 0.024) and albumin levels (p = 0.004). In patients with multiple myeloma, physical function had a significant relationship with quality of life. Low hemoglobin and albumin levels, severe disease- or treatment-related symptoms, and depression were related to decreased physical function, and thus consequentially exert an effect on quality of life in multiple myeloma patients.

Factors influencing quality of life in patients with multiple myeloma

Background: Over the course of repetitive and long-term chemotherapy treatment, multiple myeloma (MM) patients experience physical and psychological problems and side effects.Objectives: The objective of this study was to investigate the levels of pain, uncertainty, social support, anxiety, depression, and quality of life (QOL) receiving chemotherapy for MM patients and to identify psychosocial factors influencing their QOL.Methods: A cross-sectional descriptive design was used. A total of 110 MM patients receiving chemotherapy were recruited into the study. The data were collected by personal interviews using questionnaires and were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson’s correlation, and hierachial multiple regression analysis.Findings: Global health status QOL was explained by uncertainty, anxiety, and depression. Functional QOL was explained by age, uncertainty, and anxiety. Symptom QOL was explained by pain, and depression. Uncertainty, anxiety and depression were the strongest predictive factors. To improve QOL of patients with MM, nurses should focus on the factors identified in this study when doing nursing care.Impact statement: This study confirmed psychological difficulties such as uncertainty, anxiety and depression affecting quality of life of MM patients receiving chemotherapy.