HEALTH-RELATED QUALITY-OF-LIFE ASSESSED BEFORE AND DURING CHEMOTHERAPY PREDICTS FOR SURVIVAL IN MULTIPLE-MYELOMA

Measurement of health-related quality of life was integrated into a ra ndomized trial (NMSG 4/90) comparing melphalan/prednisone to melphalan /prednisone + interferon alpha-2b in newly diagnosed multiple myeloma. One of the aims of the study was to assess the prognostic significanc e of quality-of-life scores, using the EORTC QLQ-C30 questionnaire. Un ivariate analysis showed a highly significant association with surviva l from the start of therapy for physical functioning as well as role a nd cognitive functioning, global quality of life, fatigue and pain. In multivariate analysis, physical functioning and W.H.O. performance st atus were independent prognostic factors (P values = 0.001 for both) w hen analysed in a Cox regression model with the somatic variables beta -2 microglobulin, skeletal disease and age. The best prediction for su rvival from the start of therapy was obtained by combining the beta-2 microglobulin and physical functioning scores in a variable consisting of three risk factor levels with an estimated median survival of 17, 29 and 49 months, respectively. At a 12 months landmark analysis, the relative risk for patients with physical functioning score 0-20 v 80-1 00 was 5.63 (99% CI 2.76-11.49), whereas the relative risk for patient s without an objective response to chemotherapy compared to those with at least a minor response was 2.32 (99% CI 1.44-3.74). Quality-of-lif e assessment may be an independent and valuable addition to the known prognostic factors in multiple myeloma.