Original Article

Medical Oncology

, Volume 18, Issue 1, pp 65-77

First online:

Health-related quality of life in multiple myeloma patients receiving high-dose chemotherapy with autologous blood stem-cell support

  • N. GulbrandsenAffiliated withDepartment of Hematology, Ullevål University Hospital Email author 
  • , F. WisløffAffiliated withDepartment of Hematology, Ullevål University Hospital
  • , L. BrinchAffiliated withDepartment of Rikshospitalet, Ullevål University Hospital
  • , K. CarlsonAffiliated withAkademiska Hospital
  • , I. M. DahlAffiliated withTromsø University Hospital
  • , P. GimsingAffiliated withRigshospitalet
  • , E. HippeAffiliated withKobenhavn University Hospital
  • , M. HjorthAffiliated withLidkøping Hospital
  • , L. M. KnudsenAffiliated withKobenhavn University Hospital
    • , J. LamvikAffiliated withTrondheim University Hospital
    • , S. LenhoffAffiliated withLund University Hospital
    • , E. LøfvenbergAffiliated withNorrland University Hospital
    • , I. NesthusAffiliated withHaukeland Hospital
    • , J. Lanng NielsenAffiliated withArhus University Hospital
    • , I. TuressonAffiliated withMalmø University Hospital
    • , J. WestinAffiliated withLund University Hospital
    • , The Nordic Myeloma Study Group

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In a population-based study, the Nordic Myeloma Study Group found a survival advantage for high-dose melphalan with autologous blood stem-cell support compared to conventional chemotherapy in myeloma patients under 60 yr of age (risk ratio: 1.62; confidence interval [CI] 1.22–2.15; p=0.001). A study of health-related quality of life (HRQoL) was integrated in the trial, using the EORTC QLQ-C30 questionnaire. Of the 274 patients receiving intensive therapy 221 (81%) were compared to 113 (94%) of 120 patients receiving conventional melphalan-prednisone treatment.

Prior to treatment, there were no statistically significant differences in any HRQoL score between the two groups. One month after the start of induction chemotherapy, the patients on intensive treatment had more sleep disturbance than the control patients. At 6 mo, corresponding to a mean of 52 d after high-dose melphalan, the patients on intensive treatment had moderately lower scores for global QoL and role and social functioning and there was also a significantly higher score for appetite loss. At 12 and 24 mo, the HRQoL was similar to that of the control patients. At 36 mo, there was a trend toward less fatigue, pain, nausea, and appetite loss in the intensive-treatment group. Thus, the 18 mo of prolonged survival seem to be associated with a good health-related quality of life. Despite the moderate HRQoL reduction associated with the early intensive chemotherapy phase, this treatment modality must be regarded as an important step forward in the care of multiple myeloma.

Key Words

Adult hematopoetic stem-cell transplantation melphalan multiple myeloma neoplasms prospective studies quality of life questionnaires