Longitudinal Trajectories of Patient-Reported Outcomes Among Older Adults with Multiple Myeloma (MM) Following Autologous Stem Cell Transplantation (ASCT)
Authors: Badia Victoria , Doshi Apoorva , Ravi Gayathri , Bal Susan , Godby Kelly , Murdaugh Donna , Costa Luciano J. , Williams Grant , Bhatia Smita , Giri Smith 
Published: December 2024

Introduction: Quality of life (QoL), as measured by patient reported outcomes (PROs), including cognition, emotional health and global physical health, is an important consideration in treatment decision-making for older adults with multiple myeloma (MM). Prior studies have shown a short-term decline in QoL immediately following ASCT, but longer-term trajectories remain understudied, especially among older adults receiving ASCT and those treated outside of clinical trials. Therefore, the goal of this study was to understand the trajectories of PROs impacting QoL among older adults with MM during the first year following ASCT.

Methods: We included older adults ≥50y, diagnosed with MM presenting for initial consultation for ASCT at a single institution from 1/2020 to 4/2024, who were enrolled in a prospective cohort study (NCT05556928). All patients underwent a practical geriatric assessment (GA) at baseline (pre-transplant) with repeat evaluation at 3, 6 and 12 months post-ASCT. The Patient Reported Outcomes Measurement Information System (PROMIS) Global Health v1.2 was used to measure overall QoL. The PROMIS anxiety short form (4a) and the PROMIS depression short form (4a) were used to measure symptom burden of anxiety and depression, respectively. The NIH Neuro-QoL 8-item Cognitive Function subscale was used to measure burden of cognitive symptoms. Unadjusted generalized linear mixed models were used to describe the mean change from baseline to 3, 6, and 12 months. A 3-point T-score difference was considered a clinically meaningful difference for all measures- consistent with the literature.

Results: Of 303 adults presenting for initial consultation, 208 (69%) agreed to participate and 176 (58%) had at least one follow-up assessment. Participants who had at least one follow-up assessment were included in the current analysis. This patient population was 57% male, 55% non-Hispanic white and 36% Non-Hispanic Black. Most participants had IgG isotype (57%), International Staging System (ISS) stage II disease (24%) and 17% had high-risk cytogenetics (del 17/17p, t4;14 or t14;16).

Statistically significant and clinically meaningful improvement in QoL scores from baseline to 6 months was observed in physical health (mean difference from baseline +3.04; 95% CI 1.84-4.24), whereas statistically significant improvement alone was seen for emotional health (mean difference from baseline +1.6, 95% CI 0.39-2.80) subscales. Between 6 months to 1 year, there was a slight dip in both of these subscales, although overall T scores remained higher than baseline. Statistically significant improvements were seen for anxiety (mean difference from baseline -2.79, 95% CI -4.11 to -1.46), whereas depression (mean difference from baseline -0.89, 95% CI -2.08 to 0.29) and cognition (mean difference from baseline 0.21, 95% CI -1.19 to 1.60) remained unchanged from baseline to 12 months.

Conclusion: In this cohort of older adults with MM undergoing ASCT, we noted an overall improvement in patient-reported outcomes including global physical health, emotional health and anxiety burden. This finding suggests that, despite advanced age, older adults with MM can expect an improvement in their QoL in the year following ASCT. Additionally, a pattern emerged amongst most QoL trajectories, where scores improved up until 6 months before decreasing, but remaining significantly improved from baseline, at 12 months. Further work in this area could focus on identifying stressors and post-transplant therapies that may contribute to the noted decline in QoL measurements during this timeframe, as well as patient resources that may be offered to ameliorate said subsequent negative impact on QoL.