Impact of depression on adherence to lenalidomide plus low-dose dexamethasone in patients with relapsed or refractory myeloma

Abstract

Purpose

While continued lenalidomide and low-dose dexamethasone (Rd) treatment could improve survival outcomes for multiple myeloma (MM), the association of depression on the adherence to Rd regimen in myeloma patients has never been studied even though depression is a common symptom among MM patients. This study aims to evaluate the impact of depression prior to Rd treatment on adherence to the treatment among patients with MM.

Methods

This multicenter cohort study was conducted from January 2015 to October 2018 at five tertiary hospitals in Korea. Patients who completed fewer than 4 cycles, 4–11 cycles, and more than 12 cycles were categorized as the poor adherence group (PAG), moderate adherence group (MAG), and good adherence group (GAG), respectively.

Results

Among141 patients, 41.8% of them had depression before beginning Rd treatment and 46% of participants were in the GAG. Compared with patients in the GAG (30.3%), patients in the PAG were more likely to have depression at baseline (90.0%) and had the higher distress scores (6.35 vs. 4.28, P < 0.01). Presence of depression prior to Rd treatment was significantly associated with poor adherence (IRR = 6.67, 95% CI = 1.45, 30.61) after adjusting for age, sex, education, ECOG, ISS stage, number of previous treatments, and disease status prior to Rd treatment.

Conclusions

Patients with depression had a substantially high risk of poor adherence compared to patients without depression. Given that Rd treatment is mainly offered by outpatient clinics, active interventions to reduce depression should be considered for MM patients prior to Rd treatment.

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Data availability

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.

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Code availability

The primary author has full control of all codes and agrees to allow the journal to review the codes if requested.

Funding

This study was funded by grants from Celgene Korea.

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Affiliations

Authors

Contributions

Conceptualization: S.J.K., D.K and J.C

Data collection: S.J.K., Y.P., Y.C.M., K.K., J.S.K. and C.K.M

Data analysis: D.K

Writing: S.J.K. and D.K

Reviewing and editing: S.J.K., Y.P., Y.C.M., K.K., J.S.K. and C.K.M

Supervision: J.S.K., C.K.M., and J.C

Corresponding authors

Correspondence to Jin Seok Kim or Chang-Ki Min or Juhee Cho.

Ethics declarations

Ethics approval and concent to participate

The institution’s review board (IRB File No. SMC 2014-12-103) approved this study. The Institutional Review Board of the Samsung Medical Center determined this study to be exempt from obtaining informed consent from individual participants. All participating patients provided written informed consent.

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All participating patients provided written informed consent.

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The authors declare that they have no conflict of interest.

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Kim, S.J., Kang, D., Park, Y. et al. Impact of depression on adherence to lenalidomide plus low-dose dexamethasone in patients with relapsed or refractory myeloma. Support Care Cancer (2021). https://doi.org/10.1007/s00520-021-06017-y

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Keywords

  • Depression
  • Lenalidomide
  • Low-dose dexamethasone
  • Adherence
  • Myeloma