Health-related quality of life in multiple myeloma patients receiving high-dose chemotherapy with autologous blood stem-cell support

In a population-based study, the Nordic Myeloma Study Group found a surviva l advantage for high-dose melphalan with autologous blood stem-cell support compared to conventional chemotherapy in myeloma patients under 60 yr of a ge (risk ratio: 1.62; confidence interval [CI] 1.222-2.15; p=0.001). A stud y of health-related quality of life (HRQoL) was integrated in the trial, us ing the EORTC QLQ-C30 questionnaire. Of the 274 patients receiving intensiv e therapy 221 (81%) were compared to 113 (94%) of 120 patients receiving co nventional melphalan-prednisone treatment. Prior to treatment, there were no statistically significant differences in any HRQoL score between the two groups. One month after the start of induct ion chemotherapy, the patients on intensive treatment had more sleep distur bance than the control patients. At 6 mo, corresponding to a mean of 52 d a fter high-dose melphalan, the patients on intensive treatment had moderatel y lower scores for global QoL and role and social functioning and there was also a significantly higher score for appetite loss. At 12 and 24 mo, the HRQoL was similar to that of the control patients. At 36 mo, there was a tr end toward less fatigue, pain, nausea, and appetite loss in the intensive-t reatment group. Thus, the 18 mo of prolonged survival seem to be associated with a good health-related quality of life. Despite the moderate HRQoL red uction associated with the early intensive chemotherapy phase, this treatme nt modality must be regarded as an important step forward in the care of mu ltiple myeloma.