Clinical Decision-making, Prognosis, Quality of Life and Satisfaction in Relapsed/Refractory Multiple Myeloma
Clinical Decision-making, Prognosis, Quality of Life and Satisfaction in Relapsed/Refractory Multiple Myeloma
The primary objective is overall survival (OS) as predicted by baseline self-reported EORTC
 QLQ-C30 (European Organisation for Research and Treatment of Cancer Quality of Life
 Questionnaire-Core 30) fatigue scale ratings, independently from other prognostic factors for
 OS in multiple myeloma (MM), including the clinically-based prognostic frailty score.
While quality of life (QoL) and other types of patient-reported Outcomes (PROs) can be
 crucial in the management of RRMM patients, a perusal of the literature indicates a dearth of
 information in this area. PRO is defined by the US Food and Drug Administration (FDA) as "a
 measurement based on a report that comes directly from the patient (i.e., study subject)
 about the status of a patient's health condition without amendment or interpretation of the
 patient's response by a clinician or anyone else. A PRO can be measured by self-report or by
 interview provided that the interviewer records only the patient's response. Until now the
 few studies that have included PRO data have been conducted in newly diagnosed MM patients
 enrolled in randomized controlled trials (RCTs).

 For the purpose of this protocol, we have conducted a systematic review of PRO studies
 conducted in RRMM patients receiving treatments with either Imunomodulatory agents (IMiDs) or
 Proteasome inhibitors (PIs). The search was conducted for studies published from January,
 1990 to July, 2015 and yielded only eight studies published within this timeframe. Three
 studies dealt with bortezomib based regimens, two with thalidomide, and the remaining studies
 with carfilzomib, pomalidomide, and lenalidomide. In all these studies PROs were considered
 as secondary outcomes and in four this was analyzed in the context of RCTs.

 Despite enhanced disease control, none of the current novel agents, either IMiDs or PIs are
 free of significant toxicities, which frequently persist after completing treatment and
 continue to impair patient's daily functioning over the long-term period. Also, it is
 important to consider the poor prognosis for many of these patients. For example, patients
 who fail first-line PIs or IMiDs have been shown to report an average life expectancy of 9
 months from the time of becoming refractory to PIs and IMiDs. Maintaining a "good" or
 "acceptable" level of QoL and lowering symptom burden over the longest possible period of
 time is a main goal of treatment for RRMM patients. Therefore, considering the paucity of QoL
 evidence-base data, CLARITY is designed to expand on some key understudied areas in this
 population that are broadly summarized in the next two paragraphs.
Inclusion Criteria:

 -  MM patients who have received at least 1 prior line of therapy and are considered as
 RRMM according to IMWG criteria.

 -  Adult patients (≥ 18 years old).

 -  Written informed consent provided.

 -  Patients who have been enrolled onto other study therapy protocols are also eligible.

 -  Having a full baseline PRO evaluation completed.

 -  All data a available to calculate the frailty score.

 Exclusion Criteria:

 -  Having any kind of psychiatric disorder or major cognitive dysfunction hampering the
 provision of informed consent.

 -  Having reported any grade ≥3 adverse event within two weeks prior to study entry.

 -  Having received more than 5 lines of therapies.