Quality Of Life In Multiple Myeloma Research Articles

Quantitative Cross-Sectional Analyses of Quality-of-Life Outcomes Related to Race, Sex, Age, and Clinical Stage Among Multiple Myeloma Patients at an Urban Center

Introduction. Multiple myeloma (MM) patients suffer from disease symptoms and impact on quality of life (QoL) - a patient's sense of enjoyment, well-being, and ability to carry out activities of daily living. Reports on QoL in MM have focused on clinical trials that usually involve younger patients with adequate performance status (PS), mostly Caucasians. The median age of MM onset is 69 years; advanced age is associated with multiple comorbidities and deteriorating PS. Blacks have twice the incidence of MM compared to Caucasians; they also have a higher risk of dying due to poor healthcare utilization. Here, we explored the multifactorial nature of race, sex, age, and clinical stage in patient reported QoL outcomes using quantitative cross-sectional analyses from a single center in urban setting.Methods. Participants with a diagnosis of plasma cell disorders at various stages: MGUS, smoldering myeloma (SMM), or MM (newly diagnosed, maintenance, relapsed/refractory) were sequentially enrolled for a one-time measurement of QOL outcomes. Consent and study questionnaire were conducted verbally. Participants simply responded ‘yes’ or ‘no’ to nine question prompts outlined in Table 1, followed by verbal reasoning which was transcribed by the interviewer. The questionnaire included three main domains of QoL assessment based on existing literature review and feedback with our patient population. The first is physical symptoms and function (disease-related symptoms, treatment-related adverse events, sexual health and satisfaction with care), the second is mental health (depression, spirituality), and the third is social impact (financial burden, family support). Data were analyzed using chi-square test of independence. Participants will be re-approached for a second interview to determine changes to impact across the same QoL variables over time. The questionnaires validated within the current study will be used for a longitudinal cohort study to investigate whether a greater degradation is observed in one or more QoL domains during a specific time-point of MM disease course.Results. A total of 100 patients (males n=52) were enrolled. Median age was 64 years (IQR 55 - 68); 59 were Caucasian, 34 were Black, and 7 from other racial groups. At the time of interview: 7 were newly diagnosed or receiving induction therapy, 25 were undergoing stem cell transplant (SCT), 22 were on maintenance therapy, 33 were relapsed on salvage therapy, and 13 on no therapy (MGUS/SMM). Regardless of race, age, or sex, patients on therapy felt their QOL was impacted by fatigue (67%), and myeloma symptoms (65%). Black participants reported more fatigue as an impact on their QoL compared to other racial groups, p = .009. Women reported more impact from MM on sexual intimacy, p = .04, and impact from financial burden than male participants, p = .03. Younger patients <60 years old (n=38) reported more impact from treatment-related adverse events, p = .004, disease-related symptoms, p = .02, and dissatisfaction with information received about their disease and/or treatment, p = .004, compared to patients aged >60 years. Not surprisingly, patients with active MM (n=87); newly diagnosed on therapy, those undergoing SCT, or on maintenance, and relapsed disease) reported more MM symptoms p = <.001, and suffered from more fatigue, p = <.02, with higher impact on QoL compared to those with early-stage plasma cell disorders (MGUS, SMM). However, early-stage patients felt more dissatisfaction with information received and uncertainty about what to expect, p = <.001, compared to MM patients receiving therapy. Interestingly, there were no age, sex, race, or clinical stage dependent effects observed from SCT experience, spirituality or religion, and dissatisfaction with cancer care.Conclusions. Patients <60 years were impacted more by disease-related symptoms, treatment-related adverse events, in comparison to patients >60 years. Women felt their QoL was impacted by MM's affect on sexual intimacy and resulting financial burden in comparison to men. Black participants felt greater impact from fatigue in comparison to Caucasian and other races. Active MM patients on treatment were more impacted by disease-related symptoms and fatigue compared to early-stage patients. MGUS/SMM patients not on therapy were more impacted by dissatisfaction of information received compared to patients receiving treatment at time of data collection. [Display omitted] DisclosuresBadros: Janssen: Research Funding; J&J: Research Funding; BMS: Research Funding; GlaxoSmithKline: Research Funding.

MO128RETINOL BINDING PROTEIN (RBP) - NEW BIOMARKER OF KIDNEY INJURY IN MULTIPLE MYELOMA PATIENTS*

Abstract Background and Aims The aim of the study was to analyse the utility of retinol binding protein (RBP) in case of renal impairment in MM patients and investigate its relationship with acclaimed parameters of renal failure and markers of MM stages. Method We recruited 73 patients (35 women, 38 men, in age range of 29-90 years, mean 70 ± 10 years) with multiple myeloma (MM), including 6 (8%) with smoldering MM, 40 (55%) with International Staging System (ISS) stage I, 15 (21%) with ISS II and 12 (16%) with ISS III. The majority of patients (65, 89%) received at least one treatment scheme. Thirty patients (41%) received maintenance treatment at recruitment. Median eGFR based on serum creatinine (CKD-EPICr) equaled 67 (range 9 – 117) ml/min/1.73 m2. Results Significant correlation was observed between RBP and the ordered variable describing MM stage from smoldering myeloma to ISS III (R=0.36; p=0.002). There were no differences between patients in CR, PR, SD and PD at the time of samples’ collection. Patients who were on maintenance treatment at recruitment tended to have higher serum RBP (median 42.6 versus 37.7 mg/l), however, the difference was not statistically significant (p=0.068). The patients who received steroid treatment had significantly higher RBP concentrations. There were no such association with other medications. There was no association between RBP and the number of previous treatment lines (p=0.8). Serum RBP did not differ between men and women (p=0.7) and did not correlate with age (p=0.6). Significant correlations were found between RBP and serum creatinine, cystatin C and eGFR values calculated based on creatinine and/or cystatin C (Table 1). In multiple regression, serum creatinine or cystatin C and the treatment with steroids were associated with RBP independently of ISS stage (Table 2). Moreover, RBP correlated with β2-microglobulin, LDH, leukocyte count, α-klotho, FGF-23, GDF-15, uNGAL and uIGFBP-7, however, only the associations with β2-microglobulin and sTfR were independent of serum creatinine in multiple regression (Table 1). Baseline serum RBP concentration was significantly correlated with eGFR after a median of 19 months follow-up (range 1-24 months) (R=-0.35; p=0.003), however, the correlation was not independent of baseline serum creatinine ((beta ± SE: 0.06 ± 0.10; p=0.5). To the contrary, baseline serum cystatin C (beta ± SE: -0.36 ± 0.13; p=0.009) predicted final eGFR independently of baseline serum creatinine. Conclusion RBP may be useful marker in renal damage in patients with chronic kidney injury among patients with MM. This can lead to noninvasive biomarker-targeted diagnostic interventions and contribute to early beginning of treatment that may improve life expectancy quality of life in MM.

The influence of clinical stage, race, and gender on factors which impact quality of life in multiple myeloma.

e24126 Background: Multiple myeloma (MM) is unique among hematologic malignancies as an incurable disease. Patients are affected long-term by the disease symptoms as well as psychological, financial burden, and social impact, which may affect overall quality of life (QOL). The current literature related to QOL in MM is largely limited to a single clinical stage, impact concurrent with a specific treatment regimen, or focused on a single QOL factor. Changes in impact on QOL based on longitudinal follow up during the disease course have not been readily assessed. Here, we evaluated patient-reported QOL measures utilized by one time validated questionnaires. Methods: The study enrolled 100 participants in a sequential manner from the Myeloma Clinic at UMGCC with a diagnosis of plasma cell disorders at various stages: MGUS, smoldering myeloma, or multiple myeloma: newly diagnosed, maintenance, relapsed. Participants provided verbal responses to a series of questions listed in Table. Questions aligned with three main domains: physical symptoms and function, mental health, and social systems. The following is an interim analysis of the first 50 patients. Results: This sample of myeloma patients (N=50; males n=26), felt their QOL was impacted by myeloma symptoms (70%). More African American participants reported impact from financial burden (6, 50%) in comparison to Caucasian and other races (10, 26%). Interestingly, males reported less impact on sexual intimacy (3, 15%) than females (6, 43%). Females also reported more impact from financial burden (10, 42%) compared to males (6, 23%). Conclusions: Changes to impact on QOL as a function of clinical MM stage, race, and/or gender will be fully evaluated. Planned analyses include correlation statistics by age and social demographics to determine patterns in patient-reported outcomes. Finally, second interviews with current participants will be conducted to determine changes to impact across the same QOL variables over time.[Table: see text]

P0745URINE TIMP-2 AND IGFBP-7- NEW BIOMARKERS OF KIDNEY INJURY IN MULTIPLE MYELOMA PATIENTS

Abstract Background and Aims Urine tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) seem to be novel kidney injury related biomarkers, especially in tubular cells damage. Free light chains (FLCs) are associated with renal failure in multiple myeloma (MM) and appear to have a prognostic value and indicate stages in MM. The aim of the study was to investigate the correlation between new biomarkers and acclaimed parameters of renal failure and markers of MM stages and prognosis. Method The study included 124 patients with MM in the mean age of 66 +/- 10 years, with median time from MM diagnosis of 30 (lower; upper quartile 14; 63) months. There were 7(6%) patients with smoldering MM, 80(65%) with ISS stage 1, 22 (18%)with stage 2 and 15 (12%) with stage 3 MM. Mean eGFR was 71 +/- 25 ml/min/1.73 m2 and 30 (24%) patients had eGFR &amp;lt;60 ml/min/1.73 m2. The examined parameters included creatinine, urine NGAL, urine and serum cystatin-C, urine and serum FLC kappa and lambda, serum monoclonal protein, IGFBP-7 and TIMP-2 in serum and urine, WBC count, IL-6, NT-proBNP, serum albumin and β2-microglobulin. IGFBP-7 and TIMP-2 in serum were measured in a subgroup of 73 patients, including 26 (36%) with eGFR &amp;lt;60 ml/min/1.73 m2. The association between between these parameters were determined by multivariate stepwise regression analysis. The p-value &amp;lt;0.05 was considered statistically significant. Results Except for urine cystatin C and urine TIMP-2, all the studied markers were higher among patients with eGFR &amp;lt;60 ml/min/1.73m2: urine NGAL: 23.3 (9.2; 68.4) vs. 7.8 (3.9; 16.8) ng/ml; p&amp;lt;0.001; urine IGFBP-7: ; serum IGFBP-7: 86.2 (29.3; 125.0) vs. 33.7 (13.2; 61.5) ng/ml; p=0.003; and serum TIMP-2: 628 (498; 663) vs. 431 (360; 614) ng/ml; p=0.011, respectively. Serum and urine IGFBP-7 and urine NGAL were also higher among patients with ISS grade 3 comparing to the rest of the group (p=0.008, p&amp;lt;0.001 and p=0.033, respectively). Patients with smoldering myeloma did not differ from those with symptomatic disease. No differences in studied markers were observed between patients with newly diagnosed MM in comparison to those who had been treated with one or more schemes. Only urinary IGFBP-7 differed between patients who were on treatment at the time of samples’ collection (median ng/ml) in comparison to untreated (median ng/ml; p=0.009). No differences in TIMP-2 and IGFBP-7 levels in patients divided according to MM state were observed (remission vs stable vs progressive disease). In whole studied group, urinary markers of tubular injury were interrelated: cystatin C correlated positively with NGAL monomer (R=0.22; p=0.016), IGFBP-7 (R=0.26; p=0.004) and TIMP-2 (R=0.22; p=0.016), NGAL correlated positively with IGFBP-7 (R=0.39; p&amp;lt;0.001) and TIMP-2 (R=0.25; p=0.005), and IGFBP-7 correlated positively with TIMP-2 (R=0.31; p&amp;lt;0.001). In multiple linear regression, the negative correlation between urinary IGFBP-7 and eGFR was independent of other studied urinary markers of tubular injury. However, after adjustment for confounders (age, smoldering versus symptomatic MM, ISS, LDH, remission versus stable or progressive disease, and the concentrations of involved urine light chains), only urinary NGAL was independently associated with eGFR. Conclusion Urine TIMP-2 and IGFBP-7 may be useful in investigating tubular renal damage in patients with chronic kidney injury among patients with MM. This can lead to noninvasive biomarker-targeted diagnostic interventions and contribute to early beginning of treatment that may improve life expectancy quality of life in MM.

PB2265 THE RELATIONSHIPS BETWEEN QUALITY OF LIFE AND DISEASE MANAGEMENT AWARENESS, PREFERENCES AND SATISFACTION: NATION‐WIDE SURVEY OF MULTIPLE MYELOMA PATIENTS IN BELARUS

Background:Health‐related quality of life (QoL) is an important humanistic outcome of multiple myeloma (MM) management. While QoL in MM is studied in controlled clinical trials, predominantly in the European Union communities, QoL level and components data are scarcer in real‐world clinical settings. Moreover, QoL level and changes to QoL under different treatment modalities may be confounded by other patient factors which require clarification.Aims:To cover the information gaps regarding the level and patient‐ and disease‐related predictors of QoL in MM patients residing in Belarus.Methods:A cross‐sectional survey of a country‐representative sample of 300 MM patients of Belarus was performed. The survey consisted of 42 multiple choice questions including the whole EORTC QoL Core Questionnaire (EORTC QLQ‐C30, version 3.0), 3 questions from EORTC QoL Questionnaire – MM Module (EORTC QLQ‐MY20) related to attitude toward the disease course and perspectives, and additional items related to patients’ preference toward place and route of drug administration, their disease awareness, and overall satisfaction with healthcare services. Descriptive analyses were conducted.Results:Global health status/QoL of MM patients was 55.3 (95%CI 52.8 – 57.8). The main components deteriorating QoL were physical functioning, fatigue, pain and sleep disorders. QoL functional scales scores decreased and QoL symptomatic scales scores increased across age and disease duration distributions, with the QoL scores drop in patients with 3‐4 years of disease duration. Higher scores for almost all QoL functional domains were noted in patients preferring oral treatment. Majority (54%) welcomed combination (intravenous + per os) therapy, but only 28% of patients preferred sole parenteral administration of drugs. 72% of respondents considered the quality of diagnostics &amp; treatment as good or excellent, while 45% preferred to be treated in ambulatory settings and/or at home. Global and functional but not symptomatic QoL scores were directly related to the level of patients’ satisfaction with disease management. Worries about dying were revealed as a predominant negative factor for all EORTC QLQ‐C30 scores. The level of patients’ awareness (on their health status and the course of the disease, possible treatment options and side effects) significantly and positively related to their QoL levels.Summary/Conclusion:QoL of MM patients in Belarus corresponds to EORTC reference data which makes possible inter‐country comparisons and translation of humanistic outcomes of clinical trials. MM duration, patient attitude toward the disease course and overall patient satisfaction with healthcare services are important predictors of QoL. The evidence suggests that successful patient education activities per se can improve QoL of MM patients and hence their engagement in ambulatory treatment modalities. It should be better addressed in quality control and improvement measures of MM management.