PB2126 SYMPTOM BURDEN AND OXIDATIVE STRESS IN MULTIPLE MYELOMA PATIENTS IN EARLY POST‐TRANSPLANTATION PERIOD
Authors: A. Zherniakova, L. Aleksanian, T. Ionova, I. Kostroma, T. Nikitina, N. Porfir’eva, L. Rybakova, I. Zapreeva, S. Gritsaev
Journal: HemaSphere (2019)

Background: Multiple myeloma (MM) is frequent indication for high‐dose chemotherapy with autologous stem cell transplantation (ASCT) and can be associated with substantial morbidity. Understanding of symptom changes after ASCT is of importance toward developing strategies aimed at reducing the symptom burden associated with this procedure. Alongside oxidative imbalance has been viewed as a common denominator in the pathogenesis of treatment‐related morbidity and mortality in high dose therapy followed by hematopoietic stem cell transplantation (HSCT). The data about the effect of HSCT on oxidative stress in early post‐transplantational period is lacking. It is also unclear if the level of oxidative stress biomarkers is related with symptom severity experienced by patients. Aims: The aim of our study was to investigate symptom burden in MM pts and the level of oxidative stress biomarkers during the early post‐transplantation period and their possible association. Methods MM patients who underwent ASCT were included in the analysis. The MDASI questionnaire was used for symptom assessment. Pts filled MDASI before ASCT, at Day +7 after ASCT and at the day of discharge from the hospital. Plasma antioxidant status was measured by detecting the level of malondialdehyde (MDA) at day ‐1 before transplantation and Day + 7 after ASCT. MDA level was detected by the colorimetric method. Statistical analysis was performed by Wilcoxon test. For correlation analysis Spearmen correlation was used. Results: Thirty‐six MM pts were included in the analysis: median age–58.5 years; range 44‐67 years, male/female–13/23. The majority of MDASI scores increased significantly at Day + 7 after ASCT with the tendency of returning to base‐line level at discharge. At Day +7 after ASCT the symptom severity index mean value achieved 2.5 as compared with 1.6 at base‐line (p &lt; 0.002). The most pronounced increase of symptom severity at Day + 7 was observed for fatigue (ES= 0.56), drowsiness (ES = 0.6), dry mouth (ES = 0.57), nausea (ES = 1.17), loss of appetite (ES = 0.74). The MDA level was elevated before ASCT in all pts: 15.0+/‐6.97 mcmol/l. After ASCT 37.5% of pts exhibited MDA level decrease–mean value change was 3.3 mcmol/l. In this group no significant changes in symptom severity were observed (mean symptom severity index increased by 0.3). In 62.5% pts MDA level increased after ASCT: mean value change–4.3 mcmol/l. In these pts symptom severity index increased significantly (by 1.5). Correlation between changes in MDA level and symptom intensity was observed: increase of MDA level was accompanied with increase of symptom severity index; decrease of MDA level–with decrease of symptom severity index (rs = 0.44; p = 0.02). All pts with positive MDA level dynamics received lenalidomide in the induction period. Summary/Conclusion: ASCT for MM was associated with significant but reversible symptom burden during the early post‐transplantation period. Symptom burden in post‐transplantation period correlates with free‐radical oxidation activity. Detected association between symptom severity decrease and MDA level decrease may be used as an important rationale for clinical application of supportive therapy with anti‐oxidant activity in post‐transplantation period.