Triple-Class Refractory Myeloma Requires ‘Greater Attention to Symptoms'

Patients with triple-class refractory multiple myeloma (when the disease does not respond to immunomodulatory drugs, proteasome inhibitors and anti-CD38 antibodies) are likely to have significant hospitalizations and a clinically meaningful decline in health-related quality of life; according to a recent study.

Lynne I. Wagner, one of the study’s authors and a professor in the Department of Social Sciences and Healthy Policy at the Wake Forest School of Medicine in Winston-Salem, North Carolina, said this study is important for patients because the results highlight the need for paying greater attention to symptoms.

“(These results) indicate that these patients, when they transition to a triple-class resistant disease, may benefit from greater clinical attention to offer symptom palliation (and) greater clinical attention to address some possibly modifiable factors to maximize their quality of life,” she said in an interview with CURE®.

The study, results of which were presented at the 2021 American Society of Hematology Annual Meeting & Exposition, included 240 patients with multiple myeloma who had become triple-class refractory.

During the follow-up period, hospitalization for any reason and multiple myeloma-related hospitalizations occurred in 49.6% and 23.8% of patients, respectively.

There was also a significant decline in health-related quality of life from the beginning of the study to the follow-up period, as indicated by clinically meaningful deterioration in patients’ physical and functional well-being and myeloma-related concerns, Wagner said. This means these patients had worsening pain and a decreased overall health rating of themselves.

In addition, patients whose multiple myeloma is less controlled and who have more health-related issues have not only their physical and functional well-being affected but also their emotional and social well-being, she said.

Wagner added that when a patient’s disease is resistant to treatment or their multiple myeloma is triple-class refractory, it is important to remain educated about other treatment options.

“Confidence in one’s ability to manage one’s health and to manage one’s myeloma will be really important for patients who find themselves in this scenario, so they gain a greater sense of control by learning more about treatment options and engage in that important dialogue with (their) provider and their health care team with regard to treatment decision-making,” she said.

Results from the study demonstrated that patients who received subsequent lines of therapy (64%) had a median overall survival (time from diagnosis or treatment start when patients are alive) of 10.8 months, whereas those who did not receive additional therapy (35%) had a median overall survival of one month. However, Wagner noted that this was not a randomized trial, so those participants (35%) may have had a poorer health status or were too frail to receive additional lines of therapy.

“This does suggest that patients should engage in a very important conversation with their oncology team about ... the toxicities that will be introduced by any additional lines of therapy, with improved survival (as the) trade-off,” she said.

She noted that if a patient tells their health care team about their pain,
the team can implement effective interventions to relieve it. Additionally, learning coping strategies to handle uncertainty is important, she said, because having treatment-resistant disease can cause psychological distress, affecting one’s quality of life. There are coping strategies patients can learn to manage uncertainty and reduce distress, so they can maximize their quality of life in the face of a challenging disease.

“I think for the patients (whose disease is refractory to) treatment ... communicating with (their) health care team about deteriorations and (their) health-related quality of life is critically important,” she concluded.

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