Cancer-related fatigue (CRF) may be prognostic of worse progression-free survival (PFS) and overall survival (OS) among patients with newly diagnosed multiple myeloma (NDMM), according to findings published in the International Journal of Hematology.1

CRF is an adverse event commonly associated with MM treatment and has been associated with various negative outcomes, including poor quality of life and reactivation of viruses such as human herpes virus-6 (HHV-6) and human herpes virus-7 (HHV-7).  

For this prospective study, researchers investigated the incidence and effect of CRF in 16 patients with MM treated with bortezomib, lenalidomide, or thalidomide. Eleven patients had NDMM, and 5 had relapsed/refractory MM. Salivary samples were collected to measure HHV-6 and 7 reactivation during the first and second chemotherapy cycles, then on day 1 of the third cycle and following cycles. The visual analogue scale (VAS) was used to assess CRF at the same time of saliva sample harvesting.

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Overall, the incidence rate of CRF was 54.9%, and was not found to be related to treatment type.  Poor performance status (PS) was found to be significantly associated with CRF, however, with an incidence rate of 81.2% among those in the poor PS group versus 30% in the good PS group (P = .039).

After 4 months, HHS-6 and HHS-7 were reactivated in 73.1% and 45.6% of patients, respectively, but viral reactivation was not found to be associated with any particular clinical factors, including CRF.

After a median follow-up of 27.3 months, a survival analysis showed that the 2-year OS rate among patients with CRF was 20% compared with 100% among those who did not report CRF (P = .007). Similarly, PFS was 5.6 months in patients with CRF; (median PFS was not reached in patients without CRF (P = .05).

The results of this study demonstrate that CRF, a major symptom among patients with MM, can worsen survival outcomes and be predicted by poor performance status. CRF however, was not found to be associated with viral reactivation or any specific treatment type. The authors concluded that “future studies have been planned to analyze CRF-related factors including cytokines and reactivation of HHV-6 and HHV-7 in a larger cohort of NDMM.”


  1. Suzuki K, Kobayashi N, Ogasawara Y, et al. Clinical significance of cancer-related fatigue in multiple myeloma patients [published online August 28, 2018]. Int J Hematol. doi: 10.1007/s12185-018-2516-1