Meet Professor Hu Yu: Focus on the quality of life of MM and go to the road of PRO-oriented treatment optimization

Multiple myeloma (MM) is a malignant plasma cell disorder that accounts for approximately 10% of hematologic malignancies1
.
Although the emergence of new drugs and new therapies has improved the survival prognosis of MM patients, MM is still incurable, and the long-term quality of life of patients is not good
.
Patient-reported outcomes (PROs) have been shown to provide a standardized way to measure quality of life and symptom burden, enhance clinicians' understanding of patient ^health2,3, and be recommended for clinical practice to optimize patient care and outcomes
.

The 5th China International Import Expo (hereinafter referred to as the "Expo") recently opened
in Shanghai.
With the help of this big stage of China's opening up and win-win cooperation, the white paper project of "China Multiple Myeloma Patients PRO Status and Quality of Life Development Report" guided by the Health Development Research Center of the National Health Commission, hosted by Beijing Dayi Public Welfare Foundation and supported by Takeda Public Welfare was released
for the first time.
Yimaitong sincerely invited Professor Hu Yu, President of Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, to share the latest progress of the project and suggestions
for optimizing treatment and high-quality survival of patients.

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Yimaitong: The white paper project of "China Multiple Myeloma Patients PRO Status and Quality of Life Development Report" has recently been launched, can you please talk about the background and original intention of the establishment of the project, as well as the phased results achieved so far?

In recent years, with the continuous emergence of new drugs, new technologies and new methods, the basic research and clinical treatment of MM have entered a period
of rapid development.
While continuously optimizing and upgrading diagnosis and treatment plans, it has become a trend
to pay attention to the quality of life of patients.
Therefore, patient-centered and integrating quality of life into the considerations and evaluation criteria of treatment strategies is also an important direction
for the current development of MM.

The launch of the white paper project of "Report on the Status and Quality of Life Development of PRO in Multiple Myeloma Patients in China" can provide strong support for basic and clinical research of MM on the one hand; On the other hand, it can help improve the diagnosis and treatment ability of doctors and promote the standardization of
diagnosis and treatment.
Its starting point and foothold are to benefit the majority of MM patients
.

At present, the project has achieved phased results, showing the actual situation of doctors receiving MM patients and using PRO in clinical practice, and the attention
of patients at different disease stages to their own quality of life.

(1) According to the survey of doctors, from the perspective of consultation, more than half of the doctors receive less than 5 newly diagnosed MM patients and relapsed or refractory MM patients every month; From the perspective of clinical research, although more than half of the doctors (52.
3%) had previously participated in MM-related clinical studies, more than half of the doctors (51.
9%) said that they had not collected PROs
in clinical studies.

(2) The patient-side survey showed that from the perspective of disease stage, 21.
1% of patients were in the induction therapy period, 26.
3% were currently in the maintenance therapy period after induction therapy (not suitable for transplantation/before transplantation), and 14.
0% were in the maintenance therapy period
after hematopoietic stem cell transplantation.
In addition, with regard to relapse, 17.
5% of patients had a first recurrence (first recurrence) and 10.
5% had a multiline recurrence (relapse).

That is, most patients are currently in the induction therapy period or maintenance therapy period, and the recurrence rate has reached 28%, suggesting that the quality of life of patients needs to be concerned
.

Yimaitong: This project provides valuable guidance for improving the quality of life of MM patients, can you please introduce MM, its incidence and incidence trend? What is the symptom burden that patients face?

MM is a malignant plasma cell disease and the second most common malignant tumor of the hematological system, accounting for about 10% of hematologic malignancies, and tends to occur in the elderly population
.
In recent years, the incidence of MM in China has increased year by year, and the age of onset is
younger.

Common symptoms of MM include myeloma-related organ function damage, that is, "CRAB" symptoms, including increased blood calcium, renal impairment, anemia, bone disease, etc.
, which seriously affect the quality of life of patients and bring a heavy treatment burden
.
Therefore, it is necessary to carry out the white paper project of "Report on the Status and Quality of Life Development of PRO in Multiple Myeloma Patients in China" to optimize clinical treatment decisions and further improve the quality of life of
patients.

The emergence of new drugs and therapies has prompted the MM treatment model to shift to a chronic disease management model
of continuous treatment.
During the chronic disease management phase, especially when it is sometimes difficult to seek medical care, can you share some disease management methods and advice?

In recent years, with the introduction of new drugs and therapies, the survival of MM patients has been significantly prolonged, and it has been transformed into a potential and controllable chronic disease
.
New challenges in the chronic disease management phase include issues such as
drug side effects, patient adherence, and treatment burden.

When patients encounter inconvenience in seeking medical treatment, on the basis of ensuring efficacy, we recommend the use of convenient dosing and good patient compliance to achieve continuous treatment and prolong patient survival
.
Studies have shown that all-oral regimens show lower economic burden, fewer barriers to movement, lower productivity loss, and greater convenience compared with injectable dosing regimens in first-line treatment; In the treatment of relapsed/refractory disease, patients prefer all-oral regimens over injectable proteasome ^inhibitors4
.
In addition to continuous treatment, patients should actively establish healthy lifestyle habits and make reasonable plans
for their daily diet, exercise, and routine.

Yimaitong: PRO is playing an increasingly important role in clinical treatment decisions, what do you think can be done to better play the guiding role of PRO and optimize the treatment strategy of MM?

The application of PRO helps to optimize the treatment decision of MM, improve the diagnosis and treatment level of MM, and improve the quality of
life of patients.
Therefore, it is very important to give full play to the guiding role of PRO, which can be carried out from the following aspects:

(1) It is recommended that social groups including patients, doctors, and healthy people further understand PRO and its importance, promote the application of PRO in clinical practice, and maximize the benefits
in the whole process management of MM.

(2) Choosing the appropriate PRO measurement tool (PROM) is key
to implementing PRO-oriented treatment decisions.
By combining different evaluation tools and scales, a personalized PRO scale for MM is developed to ensure high-quality conclusions of PRO, which can guide the selection of regimens with better efficacy, fewer side effects, more convenient administration, and better compliance, and further improve the quality of life of
MM patients.

The "Report on the Status Quo and Quality of Life Development of PRO in Multiple Myeloma Patients in China" released the results of the phased report for the first time at the Expo, allowing the world to see China's determination
to improve the clinical treatment level of MM and innovate MM treatment models.
In the future, the promotion and application of PRO will help optimize the treatment decision of MM, thereby improving the quality of life of MM patients and achieving the goal of "Healthy China 2030" as soon as possible
.

References:

1.
Hematologist Branch of Chinese Medical Doctor Association, Hematology Branch of Chinese Medical Association.
Guidelines for the diagnosis and treatment of multiple myeloma in China (revised in 2022)[J].
Chinese Journal of Internal Medicine, 2022, 61(5):8.

2.
BMJ Open.
2018 Oct 28; 8(10):e021532.

3.
Terpos et al.
Blood Cancer Journal (2021) 11:40

4.
Dimopoulos MA, et al.
Blood Cancer J.
2020 Feb 13; 10(2)17.

Professor Hu Yu

• President of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology

• Member of the National Committee of the Chinese People's Political Consultative Conference

• Recipients of special allowances from the State Council

• Chairman-elect of Hematology Branch of Chinese Medical Association

• Vice President of Hematology Branch of Chinese Medical Doctor Association

• Vice Chairman of the Experimental Hematology Society of the Chinese Pathophysiology Society

• Chairman of Hematology Branch of Hubei Medical Association

• Editor-in-Chief of the Journal of Clinical Emergencies

• Associate Editor of Chinese Journal of Hematology

• Associate Editor of the Journal of Clinical Hematology

• Member of the editorial board of The Lancet Chinese Edition

• Project leader of the bio-targeted therapy innovation team for common major diseases of the Ministry of Education