Cancer-Related Fatigue May Be a Major Symptom in Multiple Myeloma

Cancer-relate fatigue may occur more often in patients with multiple myeloma who report with lower functional levels or performance scores, according to study results published in the International Journal of Hematology.

In addition, its incidence may predict poorer survival outcomes among new-diagnosed patients.

“Cancer-related fatigue is one of the common non-hematological adverse events in patients with malignancies and affects quality of life negatively,” the researchers wrote. “(Cancer-related fatigue) occurs due to various reasons, such as patient-related factors, treatment-related factors, inflammatory cytokines, and metabolic and/or endocrine dysregulation.”

The development of proteasome inhibitors and immunomodulatory drugs has improved the prognosis of multiple myeloma in the last 10 years; however, these agents may also increase the incidence of viral infections by the herpes family like HHV-6 and HHV-7.

While the reactivation of HHV-6 and HHV-7 may be related to fatigue in healthy individuals, its effect on those with cancer is unknown.

Therefore, the researchers prospectively analyzed the clinical significance of cancer-related fatigue and the cumulative incidence of this side effect and survival among 16 patients with multiple myeloma who were treated with Velcade (bortezomib), Revlimid (lenalidomide) or Thalomid (thalidomide).

Patients were a median of 67 years old and the majority were men. Eleven patients were newly diagnosed and five had relapsed or refractory disease.

Cancer-related fatigue at four months occurred in 54.9 percent of patients. Poor Eastern Cooperative Oncology Group (ECOG) performance scores — designed to determine a patient's level of functioning in terms of their ability to care for themselves, daily activity and physical ability – were related to cancer-related fatigue.

In addition, treatment types were not associated with the cancer-related fatigue incidence in patients, nor were the reactivation of HHV-6 and HHV-7.

The researchers found that the overall and progression-free survival among patients with newly-diagnosed multiple myeloma who reported with cancer-related fatigue was significantly shorter than in those without. For example, the two-year overall survival rate was only 20 percent in the fatigued group compared with 100 percent among those without.

“In (newly diagnosed multiple myeloma) patients, fatigue was one of the major symptoms in 32 percent of patients and related to anemia and the other symptoms due to MM,” the researchers wrote. “In addition, fatigue due to treatment was also frequently observed.”

Lastly, the researchers noted that further studies are warranted. “Future studies have been planned to analyze (cancer-related fatigue) related factors including cytokines and reactivation of HHV-6 and HHV-7 in a larger cohort of (newly-diagnosed multiple myeloma).