PROs Associated With Survival, AEs in Multiple Myeloma

Patient-reported physical function scores prior to multiple myeloma treatment can be a valuable metric in predicting patient outcomes and response to therapy, a new study has found.

The analysis, based on pooled data from 3 randomized clinical trials, highlights the importance of patient-reported outcomes (PROs) when assessing and treating patients with multiple myeloma. The study was published in the European Journal of Haematology.1

Therapies like daratumumab, bortezomib, and lenalidomide have transformed the treatment of multiple myeloma and improved outcomes for many patients, the authors noted. Yet, they explained, the development of such therapies is only part of the equation in improving multiple myeloma outcomes.

PROs are important when assessing and treating patients with multiple myeloma. | Image credit: Intelligent Horizons - stock.adobe.com

“Optimizing treatment strategies requires a more holistic approach that accounts for patient-reported perspectives,” they wrote. “A critical aspect of this approach is the integration of patient-reported outcomes.”

Several studies have suggested patient-reported physical function is an important prognostic factor for patient outcomes. For instance, one study found patient-reported physical function had a higher predictive value than Eastern Cooperative Oncology Group Performance Status (ECOG-PS) in patients with advanced non-small cell lung cancer (NSCLC) who received first-line atezolizumab (Tecentriq).2

The authors aimed to determine if a similar phenomenon might be true in patients with multiple myeloma who were receiving daratumumab-based therapy.1 They pooled data from 3 randomized trials that recorded PRO data prior to the initiation of treatment and then compared those data to outcomes including overall survival (OS), progression-free survival (PFS), and grade 3 or above adverse events. They also analyzed how patient-reported physical function compared to ECOG-PS as a prognostic tool.

Overall, 1535 participants in the trials had pretreatment PROs. The authors found that physical function, global health, and fatigue levels were the most distinct predictors of survival and adverse events. The PRO with the strongest predictive value, though, was physical function. “Moreover, physical function emerged as a predictive factor for treatment outcomes, with patients reporting low physical function demonstrating greater OS and PFS benefits with daratumumab (vs therapies without daratumumab) compared with those reporting high physical function,” they wrote.

As with NSCLC, physical function had a stronger correlation with patient outcomes than did ECOG-PS.

The investigators categorized patients as “low” and “high” in their PROs based on the 50th percentile of each subscale. Most of the patients in the data set reported “high” physical function at the start (842 participants, compared to 693 in the “low” group). Using the ECOG-PS, 761 patients were classified as having a score of 0, and the rest had a score of 1 or higher. The median follow-up among the 3 trials in the data set varied significantly, from 7.43 months to 56.2 months.

The investigators found that patients with low physical function had a greater benefit in OS and PFS from daratumumab (adjusted HR [aHR] 0.53; 95% CI, 0.40-0.70; P interaction = 0.02; and aHR 0.30; 95% CI, 0.30-0.48; P interaction = 0.03, respectively) compared to those in the high physical-function group (OS aHR 0.86; 95% CI, 0.62-1.19 and PFS aHR 0.53; 95% CI, 0.42-0.67).

The authors said their findings match a growing body of evidence supporting the use of PRO assessment in oncology as a way to enhance symptom management and improve patient quality of life. While ECOG-PS is a valuable tool, the investigators said it also has limitations, mostly due to the subjective elements of clinician assessment. They concluded that PROs ought to be seen as an inexpensive and meaningful complement to ECOG-PS when considering treatment plans for multiple myeloma.

References

1. Abuhelwa AY, Almansour SA, Basch E, et al. Predictive and Prognostic Significance of Patient-Reported Outcomes for Survival and Adverse Events in Daratumumab-Treated Multiple Myeloma. Eur J Haematol. Published online March 14, 2025. doi:10.1111/ejh.14410
2. Badaoui S, Shahnam A, McKinnon RA, Abuhelwa AY, Sorich MJ, Hopkins AM. The predictive utility of patient-reported outcomes and performance status for survival in metastatic lung cancer patients treated with chemoimmunotherapy. Transl Lung Cancer Res. 2022;11(3):432-439. doi:10.21037/tlcr-21-938