Quality of life in multiple myeloma: A scoping review Free

Background

With the increasing availability of novel therapies for multiple myeloma (MM), MM is transitioning into a chronic disease management model. Understanding the impact of available therapies on patients' quality of life (QoL) has become essential. The EORTC QLQ-C30 Global Health Status scale is a widely used to assess QoL in cancer patients. Data on QoL across different treatment regimens in MM patients are limited. This scoping review synthesizes QoL changes reported in studies of available treatments in newly diagnosed MM (NDMM) and relapsed/refractory MM (RRMM) patients.

Method

A global literature search was conducted in PubMed, Embase, and Cochrane Library from inception to April, 2025, identifying trials and real-world studies (RWS) assessing QoL using the EORTC QLQ-C30 Global Health Status scale in adult transplant-ineligible (TIE) NDMM and RRMM patients on available therapies. Scores range from 0–100, with higher indicating better health. Reported mean changes (MC) in QoL scores from baseline were narratively synthesized across follow-up intervals (≤6, 7–12, 13-24, and ＞24 months). For NDMM patients, baseline was defined separately for induction (pre-treatment) and maintenance (pre-maintenance) phases. For RRMM patients, baseline was considered as the period before the start of the current treatment. Parenteral treatments for NDMM included daratumumab (dara) –bortezomib–melphalan–prednisone (D-VMP), bortezomib–melphalan–prednisone (VMP), carfilzomib (K), and intravenous/subcutaneous daratumumab monotherapy or combination regimens. Oral treatments comprised ixazomib–dexamethasone with or without cyclophosphamide (ICd/Id), melphalan–prednisone–lenalidomide (MPR), and melphalan–prednisone–thalidomide (MPT). Treatments for RRMM were grouped by regimen class (e.g., dara-based, proteasome inhibitor (PI) + immunomodulatory drug (IMiD) combinations, and PIs/IMiDs ± other agents).

Results

Eight randomized controlled trials (n=2971) were included for NDMM. During induction, VMP tended to increase MC QoL scores, ranging from 3.9-8.8 at 0-6m, 5.6-10.5 at 7-12m, to 11.6-13.6 at 13-18m and 11.3 at 24m; values after 24m appeared relatively stable (7.9-11.3). D-VMP MC scores ranged 0.9-8.8 at 0-6m and -1.8-12.8 at 7-12m. For MPR, MC ranged 2.6-5.6 at 0-6m, 8-12.4 at 7-12m and 8.8-7.2 at 13-18m, suggesting a possible trend of improvement. MPT showed moderate stability (8.7-12.0 at 7-12m). In frail patients (frailty score≥2), ixazomib induction was associated with MC scores of 1.4-4.4 beyond 24m.

During maintenance, K showed low scores (-5.8) at 12m. MC scores of dara ranged from -3.1 to 1.6 at 0-6m, -1.8 at 12m, -0.3 to 1.2 at 13-24m. R was associated with decline from 0-6m (-4.8 to -1.7), with limited data beyond this point. T scores varied (-3 at 0-6m to 4 at 7-12m). Ixazomib MC ranged from -1.5 (6m) to 2.3 (24m). Notably, oral agents like ixazomib maintained relatively stable QoL.

Twenty-five clinical trials (n=9743) and two observational studies (n=402) were included for RRMM. Results from clinical trials showed that dara-based regimens and PI+IMiDs regimens generally demonstrated a stable QoL status. QoL scores of dara-based regimens ranged from 0.9 to 2.6 (0–6 months), 0.96 to 3.6 (7–12 months), 1.3 to 4.66 (13–24 months), and 3.1 to 3.5 (>24 months). In PI+IMiDs group, changes varied from 4.2 (0–6 months), -7.9 to 4.4 (6–12 months), -6 to 6 (12–24 months), and -2 (>24 months). The PI /IMiDs±others group showed a wide and variable range of changes, from -9.85 to 12.8 (0–6 months), -2.99 to 4.35 (6–12 months), -6 to 1.95 (12–24 months), and -12.6 to 3.09 (>24 months). Two observational studies [PI/IMiDs regimens, V-dexamethasone (d), Rd, and Pomalidomide-d] showed a stable but declined trend with -8.5 to -4.3 (6-12 months).

Conclusion

In TIE NDMM, novel agents showed consistent trends of QoL improvement during induction, with oral regimens offering more stable outcomes during maintenance. Notably, ixazomib can maintain stable long-term QoL in frail patients. This highlights the importance of treatment route in optimizing long-term QoL. While RRMM patients demonstrate poorer QoL score compared to NDMM patients, their QoL remained generally stable with PI+IMiDs, and dara-based treatment regimens. However, real-world and immunotherapy-related data were limited, warranting further research.