Inflammatory Markers and Development of Symptom Burden in Patients with Multiple Myeloma during Autologous Stem Cell Transplantation

Abstract

Purpose Increasing research suggests that inflammation mediates symptom development. In this longitudinal study, we examined inflammatory factors related to the development of high symptom burden during autologous stem cell transplant (AuSCT) for multiple myeloma. Experimental Design Patients (n = 63) repeatedly reported symptom severity on the M. D. Anderson Symptom Inventory multiple myeloma module (MDASI-MM) and contributed blood samples periodically for up to 100 days post-AuSCT for inflammatory marker assays. The temporal associations between serum inflammatory marker concentrations and symptom severity outcomes were examined by nonlinear mixed-effect modeling. Results Fatigue, pain, disturbed sleep, lack of appetite, and drowsiness were consistently the most-severe MDASI-MM symptoms during the study. Peak symptom severity occurred on day 8 post-AuSCT, during white blood cell count nadir. Patterns of serum IL-6 (peak on day 9) and sIL-6R (nadir on day 8) expression paralleled symptom development over time (both P < 0.0001). By univariate analysis, serum IL-6, sIL-6R, IL-10, CRP, MIP-1α, sIL-1R2, sIL-1RA, and sTNF-R1 were significantly related to the most-severe symptoms during the first 30 days post-AuSCT (all P < 0.05). By multivariate analysis, IL-6 (estimate = 0.170, P = 0.004) and MIP-1α (estimate = −0.172, P = 0.006) were temporally associated with the severity of the component symptom score. Conclusions Systemic inflammatory response was associated with high symptom burden during the acute phase of AuSCT. Additional research is needed to understand how the inflammatory response is mechanistically associated with symptom expression and whether suppression of this response can reduce symptoms without compromising tumor control.

Symptom recovery after thoracic surgery: Measuring patient-reported outcomes with the MD Anderson Symptom Inventory

“…Postoperative fatigue had a somewhat different pattern of recovery compared with the other major symptom outcomes in this study, peaking 2 days later (at day 5) than the other symptoms (Figure 1, Supplemental Table S1) and recovering more slowly. The leading role of fatigue in the postoperative setting is similar to that induced by other major cancer therapies, such as chemoradiation or stem-cell transplant, 21,22 and reflects the fact that there is currently no effective management strategy for this symptom. Among all MDASI data collected for a total of 13 symptoms, we identified 5 most-severe symptoms that represent a profile of the worst symptom burden for this postsurgery patient cohort.…”

Serum Cytokine Levels in Major Depressive Disorder and Its Role in Antidepressant Response

“…Markers for which more than 10% of the samples had values below limit of quantitation (LOQ) at baseline were not included in the analysis 30. Two cytokines were excluded from the analysis because they frequently had values below the LOQ (53.4% for INF-gamma, and 67.0% for MIP-1alpha).…”

Ren Shen Yangrong Tang for Fatigue in Cancer Survivors: A Phase I/II Open-Label Study

“…19,29,30 Patients reported other symptoms besides fatigue, including disturbed sleep, dry mouth, drowsiness, and poor appetite, which is consistent with symptom research findings that moderate to severe fatigue often appears alongside other significant symptoms. 3 Such evidence of the efficacy of an intervention in reducing multiple symptoms presents hope for relieving fatigue in patients with cancer. This is another reason for individualized alteration of the herbal mixture of RSYRT, by slightly changing the dose of the core or adding an additional herb.…”

“…[1][2][3] Fatigue was the most prevalent symptom reported in a quantitative study of multiple symptoms in Chinese cancer patients and survivors, 25% of whom had severe fatigue. 4 In Western countries, interventions for fatigue in the past have centered on direct management of anemia or other comorbidities, physical exercise, sleep training, neurostimulants, and antidepressants.…”