Impact of Effective Therapies on Health-Related Quality of Life Revealed in Patients With Waldenstrom Macroglobulinemia

Modern treatment for patients with Waldenstrom macroglobulinemia (WM) and immunoglobulin M (IgM)-related conditions have been shown to prolong survival, however, insight into health-related quality of life (HRQoL) after treatment in these patient populations has historically been understudied.

Researchers at Niguarda Cancer Center in Milan, Italy, conducted the first known HRQoL single-institution study to gather data on patients with WM. The results were published in Hematological Oncology with information from 143 patients, 47 of whom were previously treated, 17 with BCR inhibitor therapy, and 43 patients had no prior treatment for WM. The study also included 53 patients with IgM-MGUS/IGM-related disorders.

A Diverse Patient Population

Baseline patient characteristics showed more males than females across the 3 cohorts. The median age was 73.6 years in the pretreated WM group, 75.1 in the untreated WM group, and 72.4 in the group with IgM MGUS/IgM-related disorders. The median time to diagnosis was 95.6 months in the previously treated WM group, 78.5 in the previously treated WM, and 98.5 in the IgM MGUS/IgM-related disorders population.

In terms of disease status, the median Cumulative Illness Rating Scale (CIRS) score was 4 in the previously treated WM group, 5 in the untreated WM group, and 3 among patients with IgM MGUS/IgM-related condition. The median ECOG performance status was 1 in the previously treated WM group and 0 for the other 2 groups. Neuropathy was reported at baseline in 4 patients with previously treated disease, 9 with untreated disease, and 6 in the IgM MGUS/IgM-related disease group.

The most common systems of disease were genitourinary vascular, musculoskeletal, and respiratory system, and the common CIRS score was 3-4. Investigators led by Anna Maria Frustaci, MD, saw no statistical differenced among these 3 groups of patients in terms of the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire version 3.0 (EORTC QLQ-C30) global health status, and functional scales that include, physical, role, emotional, cognitive, and social functioning. Additionally, the symptoms scale, HADS anxiety and depression scores, and FACT-GOG neurotoxicity scores were not statistically different.

The Impact of Disease Characteristics on HRQoL

In all patients assessed, the P values determining the difference between HRQoL in the 3 study groups were calculated following the patient questionnaire. The notable results were in the EQ 5D VAS responses, which were found to be significantly worse among patients with previously treated WM compared with patients with untreated WM and those with IgM-MGUS/IgM-related disorders. The p values for response to the question of EQ 5D VAS were P =.0001 for diagnosis, P =.5174 for gender, P =.1588 for median age, P = .0742 for median age at diagnosis, P =.1278 for median time from diagnosis, P =.0224 for median CIRS score P =.0013 for median ECOG score, P =.0692 for the median number of concomitant medications, and P =.3626 for neuropathy.

Of all the disease characteristics patients were stratified by, age, higher ECOG performance

status, and higher CIRS score were determined to negatively impact HRQoL, according to the questionnaire. Although these characteristics did have a negative impact, none were detrimental except symptomatic pregabalin treatment with apparent satisfactory symptoms containment, and IGM-related neuropathy. The disease characteristic found to have no impact on HRQoL was the median time from diagnosis.

Frustaci et al also conducted a bivariate linear regression model analysis to measure differences between the 3 cohorts. Diagnosis alone was not found to be associated with HRQoL, including depression per the Hospital Anxiety and Depression Scale. High ECOG status, on the other hand, had a significant impact on global health status and physical, role, cognitive, and social functioning. Notably, anxiousness was seen most commonly in patients with WM compared with those who had IgM-MGUS/IgM-related disorders. ECOG and neuropathy impacted the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group score, which was an expected result.

The results of this study mirror what is seen in daily practice, Frustaci et al noted. The results can, therefore, be helpful for physicians as that make decisions on how to treat patients with WM or IgM-MGUS/IGM-related disorders, the investigator added. In conclusion, these results may solidify the need to do HRQoL assessments more, wrote Frustaci et al.

_Reference:

_{Frustaci AM, Tedeschi A, Nichelatti, et al. Health-related quality of life in Waldenstrom}

_{macroglobulinemia and IgM-related disorders: A single institution experience. Hematological Oncol. 2020. 38:111-113. doi:10.1002/hon.2699}