Trajectory of symptoms in patients undergoing autologous stem cell transplant for multiple myeloma: a population-based cohort study of patient-reported outcomes

Background — Autologous stem cell transplant (ASCT) is an established treatment for patients with newly diagnosed multiple myeloma (NDMM). Understanding the symptom burden associated with ASCT may be an important consideration for NDMM patients when selecting treatment options.

Methods — We conducted a population-based study of patients that underwent an ASCT for NDMM in Ontario, Canada between 2007-2018. The patient-reported outcome, Edmonton Symptom Assessment System (ESAS) score, which captures nine common cancer associated symptoms, and is routinely collected at all outpatient visits, was linked to provincial administrative health-care data. The monthly prevalence of moderate or severe symptoms (ESAS ≥ 4) each month in the first year following ASCT was analyzed. Multivariable logistic regression model was used to identify factors associated with moderate to severe symptoms.

Results — 12,820 unique symptom assessments were captured among the included 1,969 patients who underwent an ASCT. Symptom burden was highest at one-month post-ASCT with moderate to severe tiredness and impaired well-being representing the two most common symptoms. Symptom burden substantially improved by three months post-ASCT reaching a new baseline for the year following. On multivariable analysis, female sex, increased co-morbidities, earlier year of diagnosis and myeloma related end-organ damage, specifically bone and kidney disease, were associated with a higher odds of reporting moderate to severe symptoms.

Conclusion — In this large population-based study using patient reported outcomes, there was a substantial burden of symptoms noted among NDMM patients one-month post-ASCT, which improved over time. Tailored supportive care interventions should focus on strategies to optimize management of identified symptoms.