Quality of Life Assessment for Patients with Multiple Myeloma after Tandem Autologous Stem Cell Transplantation

Background: A sole focus on life prolongation does not adequately reflect the tolerability and acceptability of a proposed intervention on the patient’s perceived quality of life. As healthcare providers, our primary concern is to our patients and therefore, we should utilise measures of overall survival in conjunction with quality of life in order to deliver the best possible patient outcomes as guided by an individualised approach.

Patients and methods: We assessed patients diagnosed with multiple myeloma who were undergoing tandem autologous stem cell transplantation (ASCT) according to our protocol at the Launceston General Hospital (LGH) from March 2006 to March 2008. Patients aged below 60 years received a conditioning regimen with 140mg/m² Melphlan, while patients above 60 years received 100mg/m² Melphalan. Of the twenty recruited patients with multiple myeloma undergoing tandem ASCT, 17 were eligible for assessment of quality of life. The median age was 49 years (range 37–70 years). A full patient profile was collected including demographic and medical data and risk factors for multiple myeloma. Assessment of quality of life was made using The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life QLQ-C30 questionnaire, conducted via interviews directly after each transplant and regularly thereafter every 3 months. The tandem transplants were well tolerated without any reported cases of mucositis or nausea or vomiting that requires parenteral nutrition.

Results: Assessment of the gastrointestinal symptoms during both transplants showed that about 70% of the patients suffered from some degree of nausea and vomiting as well as loss of appetite compared to only 6–10% post transplant on further follow up. About 57% of patients suffered mild to moderate constipation and 35% complained of diarrhoea during both transplants. In the first quarterly follow up post transplant 45% of the patients had mild constipation most likely related to ongoing medication for myeloma and pain and no patients complained of diarrhoea. Assessment of patient role showed that 90% of patients had moderate to severely-affected normal social activities during both transplants with an improvement to 20–40% impairment after transplant in further quarterly follow up mainly due to chronic disease. Approximately 55% of patients experienced emotional disability during both transplants compared to 20% post transplant. None of them required specific treatment. Interestingly, about 70% reported significant financial difficulties during transplants compared to 40% after transplant follow up. About 50% of patients after each transplant have experienced moderate fatigue, mild dyspnoea and mild physical impairment. In the 3 monthly follow up this declined to 20%. Also, 50% of patients did complain to some degree of insomnia during both transplants with further improvement to 13 % after transplant. Assessment of quality of life revealed that the mean Global Health measure to be 3.44 (1=very poor, 7=excellent), and a mean Global Quality of Life of 3.61. There were no statistical differences in both scores between both transplants. However, the mean Global Health score significantly improved to 4.50 and the mean Global Quality of Life to 4.71 at quarterly follow-up. In summary, our analysis shows that dose-modified tandem transplant therapy is well tolerated with acceptable toxicity and side effects albeit the significant changes in quality of life during both transplants. Nevertheless, the post transplant follow up showed significant improvement in the quality of life that certainly reflects positively in the overall disease outcome.