Health-related quality of life in non-transplant eligible newly diagnosed multiple myeloma patients treated with melphalan/prednisolone plus either thalidomide or lenalidomide; results of the HOVON87/NMSG18 study
Why this work is in the frame
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Bibliographic record
Abstract
Aims: The aim is to evaluate the health-related quality of life (HRQoL) results of HOVON87/NMSG18 study (Zweegman et al., Blood 2016;127(9):1109-1116). Non-transplant eligible, newly diagnosed multiple myeloma patients were randomized between melphalan/prednisolone plus either thalidomide or lenalidomide for nine induction cycles, followed by thalidomide or lenalidomide maintenance (MPT-T or MRP-R). The study showed comparable efficacy of treatment. Methods: The validated instruments, EORTC QLQ-C30 and EORTC QLQ-MY20, were used for HRQoL measurement and were optional in the study. The patients answered the questionnaires at baseline, after 3 and 9 induction cycles and after 6 and 12 months of maintenance. Changes in HRQoL score over time during treatment and between groups were evaluated according to previously published levels of minimal important difference. Results: 613 of the total of 637 randomized patients chose to participate in the HRQoL reporting, and the baseline questionnaire was available from 553 patients (90.2%). Patient drop-out during follow-up was due to progressive disease, toxicity, death and other, and reduced the number of patients completing the therapy to 42 (15%) patients in the MPT-T and 93 (33%) in the MPR-R group. Both groups reported clinically meaningful improvement in global quality of life (QoL), physical functioning, pain, disease symptoms and insomnia. In the evaluation of difference between groups, the patients receiving MPR-R reported increasing diarrhea, better controlled pain at induction phase and increased global QoL and physical functioning during maintenance phase compared to MPT-T. The patients receiving MPT-T reported increasing constipation, better controlled pain during maintenance phase, better controlled fatigue during induction treatment and decreased insomnia compared to MPR-R. Conclusions: HRQoL during treatment is important to myeloma patients, especially when treatment efficacy of the treatment regimens is comparable. MPR-R and MPT-T both demonstrated improvements in global QoL, physical functioning and pain. Fatigue and insomnia were better controlled in the MPT-T group, which can be attributed to the thalidomide side effect of sleepiness. For interpretation of the HRQoL results patient drop-out rate must be taken in account, and we will recommend a HRQoL study design with high focus on data completeness and registration of reasons for missing data. (Figure Presented).
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it