How do bortezomib, thalidomide, dexamethasone and daratumumab impact the quality of life of patients with multiple myeloma?

This study evaluated the health-related quality of life of patients with multiple myeloma (MM) after treatment with VTd (bortezomib, thalidomide, and dexamethasone) with or without daratumumab (D; Darzalex). The study found that all patients that received treatment had an improved quality of life, while those treated with VTd with daratumumab (D-VTd) reported a greater improvement.

MM is a type of blood cancer. Therapy for MM can include chemotherapy (CT), immunotherapy (IT) or targeted therapy (TT) to destroy the cancer cells. This is called induction therapy. However, this can also destroy the patient’s healthy stem cells. To replace stem cells, an autologous hematopoietic stem cell transplant (HSCT) can be given. For HSCT, healthy stem cells are taken from the patient before induction therapy and infused back after. An HSCT is usually followed up with more therapy to ensure all the cancer cells have been destroyed (consolidation therapy).

Patients with MM can experience a high rate of severe side effects after treatment. These side effects negatively impact their health-related quality of life (HRQoL). The VTd regimen can be used to treat patients before and after HSCT. Daratumumab is an IT that has been shown to improve HSCT success. Studies have shown that patients treated with D-VTd have a better outcome than those treated with VTD. However, it is not clear how D-VTd impacts HRQoL in these patients.

This study included 1085 patients with MM who had an HSCT. 543 patients were given D-VTd before and after HSCT. 542 patients were given VTd before and after HSCT. Patients reported their HRQoL by completing questionnaires before and after treatment.

All patients reported an improvement in HRQoL after treatment. Patients in both groups reported a significant decrease in pain. Patients in both groups reported an increase in shortness of breath.

Patients in the D-VTd group reported a larger decrease in pain (-23.3) than the VTD group (-19.7). The D-VTd group reported a smaller decrease in cognitive (mental) function (-5) compared to -7.9 in the VTd group. The D-VTd group also reported a larger improvement in emotional functioning (+13) compared to +9.5 in the VTd group.

This study showed that both D-VTd and VTd regimens improve patients' HRQoL, while patients treated with D-VTd reported a larger reduction in pain, larger improvement in emotional function, and less worsening of cognitive function.

This study did not directly compare the HRQoL of patients treated with D-VTD to VTD. They only reported data comparing HRQoL before and after treatment. The study was partially funded by Janssen Pharmaceuticals who manufacture bortezomib and daratumumab.