Duke University School of Medicine, Durham, NC, USA.
Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
Support Care Cancer. 2024 Nov 18;32(12):802. doi: 10.1007/s00520-024-08985-3.
Patients with multiple myeloma (MM) experience significant symptom burden. We used a symptom monitoring app to longitudinally characterize the MM treatment experience in detail based on line of therapy (LOT).
Adults with MM on active treatment completed weekly symptom monitoring surveys. Patients on their 4th LOT or greater were considered heavily pretreated. We characterized moderate to very severe (MOD-VS) symptom prevalence, weekly symptom burden, symptom bother (FACT-GP5), and health-related quality of life (HR-QoL) (EORTC QLQ-C30 Item 30) per LOT.
We considered 109 patients on LOT < 4 and 47 on LOT ≥ 4. The top MOD-VS symptoms were fatigue (71.6% of patients), muscle pain (59.8%), general pain (51.6%), numbness/tingling (48.4%), and insomnia (47.6%). More patients on LOT ≥ 4 experienced numbness/tingling (66.7% vs. 41.3%; OR 2.84, 95% CI 1.27-6.37; p = 0.0098) and fatigue (83.3% vs. 65.6%; OR 2.60, 95% CI 0.96-7.09; p = 0.0557). Some symptoms (fatigue, muscle pain, anxiety) persisted for months among patients on LOT ≥ 4, but patients on LOT < 4 also had unmet longitudinal needs (numbness/tingling, dyspnea). Patients on LOT ≥ 4 had more weeks with ≥ 3 MOD-VS symptoms (27.1% of weeks vs. 15.7%; OR 2.56, 95% CI 1.07-6.08; p = 0.0337) and experienced high symptom bother more often (39.1% of surveys vs. 30.0%; OR 4.23, 95% CI 1.37-13.10; p = 0.0123). HR-QoL was similar between groups.
Heavily pretreated patients experienced greater symptom burden and bother, but patients at earlier LOTs also had unmet needs. Interventions are needed to improve symptom management in MM regardless of LOT, but most pressingly for heavily pretreated patients.
多发性骨髓瘤（MM）患者会经历显著的症状负担。我们使用症状监测应用程序根据治疗线（LOT）详细描述 MM 治疗体验。
正在接受积极治疗的 MM 成年患者每周完成症状监测调查。第 4 次或更多次 LOT 的患者被认为是预处理过多的患者。我们根据 LOT 描述了中度至非常严重（MOD-VS）症状的患病率、每周症状负担、症状困扰（FACT-GP5）和健康相关生活质量（HR-QoL）（EORTC QLQ-C30 项目 30）。
我们考虑了 109 名 LOT<4 的患者和 47 名 LOT≥4 的患者。MOD-VS 最严重的症状是疲劳（71.6%的患者）、肌肉疼痛（59.8%）、一般性疼痛（51.6%）、麻木/刺痛（48.4%）和失眠（47.6%）。更多 LOT≥4 的患者经历麻木/刺痛（66.7%比 41.3%；OR 2.84，95%CI 1.27-6.37；p=0.0098）和疲劳（83.3%比 65.6%；OR 2.60，95%CI 0.96-7.09；p=0.0557）。在 LOT≥4 的患者中，一些症状（疲劳、肌肉疼痛、焦虑）持续数月，但 LOT<4 的患者也存在未满足的纵向需求（麻木/刺痛、呼吸困难）。LOT≥4 的患者每周有≥3 个 MOD-VS 症状的周数更多（27.1%的周比 15.7%；OR 2.56，95%CI 1.07-6.08；p=0.0337），并且更频繁地经历高症状困扰（39.1%的调查比 30.0%；OR 4.23，95%CI 1.37-13.10；p=0.0123）。两组之间的 HR-QoL 相似。
预处理过多的患者经历了更大的症状负担和困扰，但早期 LOT 的患者也有未满足的需求。无论 LOT 如何，都需要干预措施来改善 MM 的症状管理，但对于预处理过多的患者来说，最紧迫的是。
