BACKGROUND: Two randomized trials have demonstrated improved progression-free survival (PFS) with lenalidomide maintenance after autologous transplantation for multiple myeloma (MM). Overall survival (OS) results are conflicting, and quality-of-life (QOL) data are lacking. The authors conducted a systematic survey of patients with MM regarding what constitutes a meaningful benefit that would make burdens of maintenance treatments (toxicity and cost) acceptable. METHODS: A self-administered survey was mailed to 1159 consecutive, living patients who were evaluated at Mayo Clinic. The survey provided background information on the standard of care for MM and data on maintenance. Patients were asked to estimate the magnitude of OS benefit that would be acceptable for various degrees of toxicity and cost. RESULTS:Of 1159 surveys sent, 886 patients (83.2%) responded, and 736 patients returned a completed survey (66% raw response rate). The most worrisome potential toxicity was identified as peripheral neuropathy by 27% of patients, cytopenias by 24%, deep vein thrombosis by 20%, fatigue by 15%, nausea by 8%, and diarrhea/constipation by 7%. If treatment was free, had no toxicity, and the OS benefit was ≤1 year, then 49% of patients indicated that they would choose maintenance; with moderate toxicity, this proportion decreased to 42%. Adding a treatment cost of $25 per month decreased the proportion that would choose maintenance to 39% of patients. CONCLUSIONS: The current results indicated that willingness to receive maintenance treatment declined when actual benefits were provided in concrete numeric terms compared with a general statement of PFS benefit. The authors also observed that the magnitude of benefit required to consider maintenance was affected by cost and toxicity.
RCT Entities:
BACKGROUND: Two randomized trials have demonstrated improved progression-free survival (PFS) with lenalidomide maintenance after autologous transplantation for multiple myeloma (MM). Overall survival (OS) results are conflicting, and quality-of-life (QOL) data are lacking. The authors conducted a systematic survey of patients with MM regarding what constitutes a meaningful benefit that would make burdens of maintenance treatments (toxicity and cost) acceptable. METHODS: A self-administered survey was mailed to 1159 consecutive, living patients who were evaluated at Mayo Clinic. The survey provided background information on the standard of care for MM and data on maintenance. Patients were asked to estimate the magnitude of OS benefit that would be acceptable for various degrees of toxicity and cost. RESULTS: Of 1159 surveys sent, 886 patients (83.2%) responded, and 736 patients returned a completed survey (66% raw response rate). The most worrisome potential toxicity was identified as peripheral neuropathy by 27% of patients, cytopenias by 24%, deep vein thrombosis by 20%, fatigue by 15%, nausea by 8%, and diarrhea/constipation by 7%. If treatment was free, had no toxicity, and the OS benefit was ≤1 year, then 49% of patients indicated that they would choose maintenance; with moderate toxicity, this proportion decreased to 42%. Adding a treatment cost of $25 per month decreased the proportion that would choose maintenance to 39% of patients. CONCLUSIONS: The current results indicated that willingness to receive maintenance treatment declined when actual benefits were provided in concrete numeric terms compared with a general statement of PFS benefit. The authors also observed that the magnitude of benefit required to consider maintenance was affected by cost and toxicity.
Authors: Robert Z Orlowski; Thomas E Stinchcombe; Beverly S Mitchell; Thomas C Shea; Albert S Baldwin; Stephanie Stahl; Julian Adams; Dixie-Lee Esseltine; Peter J Elliott; Christine S Pien; Roberto Guerciolini; Jessica K Anderson; Natalie D Depcik-Smith; Rita Bhagat; Mary Jo Lehman; Steven C Novick; Owen A O'Connor; Steven L Soignet Journal: J Clin Oncol Date: 2002-11-15 Impact factor: 44.544
Authors: B Barlogie; R Desikan; P Eddlemon; T Spencer; J Zeldis; N Munshi; A Badros; M Zangari; E Anaissie; J Epstein; J Shaughnessy; D Ayers; D Spoon; G Tricot Journal: Blood Date: 2001-07-15 Impact factor: 22.113
Authors: A Palumbo; L Giaccone; A Bertola; P Pregno; S Bringhen; C Rus; S Triolo; E Gallo; A Pileri; M Boccadoro Journal: Haematologica Date: 2001-04 Impact factor: 9.941
Authors: M Hus; A Dmoszynska; M Soroka-Wojtaszko; D Jawniak; W Legiec; H Ciepnuch; A Hellmann; T Wolska-Smolen; A Skotnicki; J Manko Journal: Haematologica Date: 2001-04 Impact factor: 9.941
Authors: Paul G Richardson; Robert L Schlossman; Edie Weller; Teru Hideshima; Constantine Mitsiades; Faith Davies; Richard LeBlanc; Laurence P Catley; Deborah Doss; Kathleen Kelly; Mary McKenney; Julie Mechlowicz; Andrea Freeman; Reggie Deocampo; Rebecca Rich; Joan J Ryoo; Dharminder Chauhan; Kathe Balinski; Jerome Zeldis; Kenneth C Anderson Journal: Blood Date: 2002-11-01 Impact factor: 22.113
Authors: S Singhal; J Mehta; R Desikan; D Ayers; P Roberson; P Eddlemon; N Munshi; E Anaissie; C Wilson; M Dhodapkar; J Zeddis; B Barlogie Journal: N Engl J Med Date: 1999-11-18 Impact factor: 91.245
Authors: N Gulbrandsen; F Wisløff; L Brinch; K Carlson; I M Dahl; P Gimsing; E Hippe; M Hjorth; L M Knudsen; J Lamvik; S Lenhoff; E Løfvenberg; I Nesthus; J L Nielsen; I Turesson; J Westin Journal: Med Oncol Date: 2001 Impact factor: 3.064
Authors: Heinz Ludwig; Pieter Sonneveld; Faith Davies; Joan Bladé; Mario Boccadoro; Michele Cavo; Gareth Morgan; Javier de la Rubia; Michel Delforge; Meletios Dimopoulos; Hermann Einsele; Thierry Facon; Hartmut Goldschmidt; Philippe Moreau; Hareth Nahi; Torben Plesner; Jesús San-Miguel; Roman Hajek; Pia Sondergeld; Antonio Palumbo Journal: Oncologist Date: 2014-07-25