Prognostic Impact of Patient-Reported Symptoms in Multiple Myeloma

Patient-reported outcomes (PROs) are associated with treatment outcomes in multiple myeloma (MM) in the clinical trial setting. However, most PRO tools are time consuming, which hinders use in routine practice. Our institution incorporated a "Hematology Patient-Reported Symptom Screen" (HPRSS), a 3-item questionnaire for fatigue, pain, and quality of life (QOL). The main objective of this study was to evaluate the impact of these symptoms on progression-free (PFS) and overall survival (OS) in real-world cohort patients with newly diagnosed MM. This retrospective study included MM patients diagnosed between April 2011-December 2017, seen at Mayo Clinic (Rochester MN), who completed the HPRSS. Patients rated their symptoms on a scale from 0-10. Clinically relevant symptoms were defined as scores ≥5 for pain and fatigue, and ≤5 for QOL. At diagnosis, 735 patients had scores for all domains. The median follow-up was 8.1 years. Age was associated with increased odds of fatigue and decreased QOL. Female sex and comorbidities were associated with fatigue and pain. Higher disease stage, anemia, lytic lesions, and plasma cell burden were associated with fatigue, pain, and decreased QOL. Clinically relevant fatigue, pain, and decreased QOL were associated with decreased PFS and OS. On multivariate analysis including age, ISS III, high-risk cytogenetics, and post-induction transplantation, fatigue and decreased QOL were independently associated with decreased OS. A composite HPRSS score stratified patients into three groups with distinct OS. Patient-reported symptoms are prognostic in newly diagnosed MM patients. The prognostic values of fatigue and QOL are independent of age, stage, and transplant.