Longitudinal analysis of patient-reported symptoms post-autologous stem cell transplant and their relationship to inflammation in patients with multiple myeloma

Abstract

After autologous stem cell transplant (AuSCT), patients with multiple myeloma (MM) may receive lenalidomide maintenance therapy. This longitudinal study examined patient-reported symptom burden during the 3–9 months post-AuSCT and its association with maintenance therapy and circulating inflammatory markers. Fifty-one patients with MM rated symptom severity weekly using the MD Anderson Symptom Inventory MM module. When possible, blood for inflammatory marker assay was drawn at enrollment. Trajectory analysis identified clusters of patients who consistently reported higher or lower symptom severity. Although disease was relatively stable 3–9 months post-AuSCT, patients were not symptom-free: 35% were in the high-symptom group. Fatigue, pain, numbness/tingling, bone aches and muscle weakness were the most severe symptoms. Controlled for clinical variables, elevated baseline tumor necrosis factor-α (TNF-α) predicted high-symptom group membership (p = 0.014). Maintenance therapy and tumor response were not related to high symptom burden. Associations between inflammation and symptom burden in this exploratory study warrant further confirmatory study.

Keywords::

• Symptom
• inflammation
• patient-reported outcome (PRO)
• maintenance therapy
• MD Anderson Symptom Inventory (MDASI)
• multiple myeloma

Acknowledgments

The authors acknowledge editorial assistance from Jeanie F. Woodruff, BS, ELS and data collection and management from Jackie Joy, Venus M. Ilagan, BA, CCRP, Brooke White and Gary M. Mobley, BS, MA.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article at www.informahealthcare.com/lal.

This study was supported by grants from the NCI, including NCI P01 CA124787 to Charles Cleeland and MD Anderson Cancer Center Support Grant NCI P30 CA016672. Robert Orlowski acknowledges support from the MD Anderson Cancer Center SPORE in Multiple Myeloma (NCI P50 CA142509) and the Diane & John Grace Family Foundation.