Patient Pain, QoL Associated With Salvage ASCT in Myeloma Must Be Balanced With Survival Benefit

Although patients undergoing salvage autologous stem cell transplantation (ASCT) for multiple myeloma may experience some pain and negative effects on quality of life, these should be carefully considered alongside the benefit of this treatment approach, according to results of a secondary outcome analysis from the Myeloma X trial.¹

The Myeloma X trial, which compared salvage transplant with nontransplantation consolidation in 288 patients with relapsed disease after prior transplant, demonstrated a significant benefit of salvage ASCT on overall survival. Here, secondary outcomes data for pain and quality of life were analyzed.

With a median follow-up of 52 months, global health scores were better among patients in the nontransplant consolidation group at 100 days after randomization (P =.496), but at no other later time points.

“This deterioration in global health status for patients receiving salvage ASCT compared with nontransplantation consolidation dissipated to a trivial difference at 6 months and a smaller trivial difference at 1 year,” the researchers noted.

At 6 months postrandomization, worse pain scores were reported for patients who underwent salvage transplant compared with nontransplant consolidation (P =.0267). As far out as 2 years, patients who underwent salvage transplant reported worse pain interference with daily living.

The researchers acknowledged several limitations to the study included its open-label design and the reliance on patient reports collected via paper-based questionnaires.

“The benefits of sASCT should be considered alongside the relatively short-term negative effects on QoL and pain when making patient treatment decisions and further support the use of sASCT,” the researchers concluded.

Reference

1. Ahmedzai SH, Snowden JA, Ashcroft AJ, et al. Patient-reported outcome results from the open-label randomized phase III myeloma X trial evaluating salvage autologous stem-cell transplantation in relapsed multiple myeloma [published online April 10, 2019]. J Clin Oncol. doi: 10.1200/JCO.18.01006