Clinical significance of cancer-related fatigue in multiple myeloma patients
Cancer-related fatigue (CRF) is one of the adverse events in multiple myeloma (MM) patients treated with cytotoxic agents, proteasome inhibitors (PIs), and immunomodulatory drugs (IMiDs) such as bortezomib, lenalidomide, and thalidomide. The aims of our study were to prospectively analyze the clinical significance of CRF, and to evaluate the cumulative incidence of CRF and the survival rates of 16 MM patients who were treated with PIs and IMiDs. Reactivation of salivary human herpes virus (HHV)-6 and HHV-7 was analyzed using real-time quantitative polymerase chain reaction (qPCR). CRF was evaluated using a visual analog scale (VAS). Eleven newly diagnosed multiple myeloma (NDMM) and five relapsed or refractory MM patients were enrolled in this study. The cumulative incidence of CRF was 54.9%. The treatment types were not associated with the CRF incidence. The cumulative incidence of reactivation of HHV-6 and HHV-7 was 73.1% and 45.6%, respectively. However, the reactivation of HHV-6 and HHV-7 was not related to CRF. The overall survival (OS) and progression-free survival (PFS) in NDMM patients with CRF was significantly shorter than in those without CRF. In conclusion, CRF was one of the major symptoms in MM patients, and predicted shorter OS and PFS in NDMM patients.
KeywordsMultiple myeloma Fatigue Human herpes virus-6
We thank our attending doctors, dedicated fellows, and nurses at the Jikei University School of Medicine. In addition, we appreciate laboratory technicians of Department of Virology. And we offer special thanks to our MM patients and their families.
Compliance with ethical standards
Conflict of interest
K.K. has submitted a patent application entitled “Methods for Assessing Fatigue Level and Applications Thereof” US patent application publication 2008/0280283 A1. K.K. has stock in Virus Ikagaku Kenkyusho Inc. This work was supported in part by the Ministry of Education, Culture, Sports, Science and Technology (MEXT)-Supported Program for the Strategic Research Foundation at Private Universities (Grant number S1201032); Virus Ikagaku Kenkyusho Inc. The other authors indicated no potential conflicts of interest.
- 2.Brown RD, Pope B, Murray A, Esdale W, Sze DM, Gibson J, et al. Dendritic cells from patients with myeloma are numerically normal but functionally defective as they fail to up-regulate CD80 (B7–1) expression after huCD40LT stimulation because of inhibition by transforming growth factor-beta1 and interleukin-10. Blood. 2001;98:2992–8.CrossRefGoogle Scholar
- 6.Harousseau JL, Attal M, Avet-Loiseau H, Marit G, Caillot D, Mohty M, et al. Bortezomib plus dexamethasone is superior to vincristine plus doxorubicin plus dexamethasone as induction treatment prior to autologous stem-cell transplantation in newly diagnosed multiple myeloma: results of the IFM 2005-01 phase III trial. J Clin Oncol. 2010;28:4621–9.CrossRefGoogle Scholar
- 16.Gautheret-Dejean A, Manichanh C, Thien-Ah-Koon F, Fillet AM, Mangeney N, Vidaud M, et al. Development of a real-time polymerase chain reaction assay for the diagnosis of human herpesvirus-6 infection and application to bone marrow transplant patients. J Virol Methods. 2002;100:27–35.CrossRefGoogle Scholar
- 20.Dimopoulos MA, Chen C, Spencer A, Niesvizky R, Attal M, Standtmauer EA, et al. Long-term follow-up on overall survival from MM-009 and MM-010 phase III trials of lenalidomide plus dexamethasone in patients with relapsed or refractory multiple myeloma. Leukemia. 2009;23:2147–52.CrossRefGoogle Scholar
- 24.Kyle RA. Multiple myeloma: review of 869 cases. Mayo Clinic Proc. 1975;50:29–40.Google Scholar