Patient-reported outcomes and skeletal symptoms in multiple myeloma stratified by proteasome inhibitor-based therapy: a prospective interdisciplinary cohort study.
7 affiliations
- 1Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany. [email protected].
- 2Comprehensive Cancer Center Freiburg (CCCF), Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany. [email protected].
- 3Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.
- 4Comprehensive Cancer Center Freiburg (CCCF), Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.
- 5Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
- 6Clinical Trials Unit, Medical Center, Faculty of Medicine, Medical Clinic, University of Freiburg, Freiburg, Germany.
- 7Department of Medicine, Hematology and Oncology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.
Abstract
Background
Multiple myeloma (MM) frequently causes osteolytic bone disease and skeletal symptoms. Proteasome inhibitors (PIs) are central to MM treatment and in routine practice, PI-based therapy is preferentially selected for patients with more active or symptomatic disease. Hereby, PIs may also exert bone-modulating effects beyond their antimyeloma activity. Whether these biological effects are reflected in patient-reported outcomes or skeletal symptoms during routine care remains unclear.Methods
We prospectively enrolled 209 patients with MM during routine interdisciplinary follow-up and stratified them by current PI-based versus non-PI-based treatment status. Sixty-nine patients were reassessed after at least 6 months. Patient-reported outcomes and skeletal symptoms were evaluated using multivariable regression and sensitivity analyses addressing baseline imbalances and treatment selection.Results
Seventy-eight patients (37%) were currently receiving PI-based treatment. In adjusted analyses, current PI-based treatment status was not associated with Quality of Life (β = -0.08, 95% CI -0.45 to 0.29; p = 0.662), health-related status (β = -0.06, 95% CI -0.42 to 0.30; p = 0.740), bone pain (OR 0.92, 95% CI 0.48 to 1.74; p = 0.791), or prevalent osteolytic lesions (OR 1.26, 95% CI 0.53 to 2.96; p = 0.601). QoL and health-related status remained comparable during follow-up. MM-related bone pain was numerically more frequent among patients currently receiving PI-based treatment (46% vs. 33%), although the association did not reach statistical significance after multivariable adjustment (OR 1.80, 95% CI 0.93 to 3.48; p = 0.081).Conclusions
In this prospective real-world cohort, current PI-based treatment status was not associated with measurable differences in global patient-reported outcomes, overall bone pain, or prevalent osteolytic lesions compared with non-PI-based treatment. MM-related bone pain was numerically more frequent among patients currently receiving PI-based treatment, although the association did not reach statistical significance after multivariable adjustment. These findings provide a real-world description of patient-reported and skeletal outcomes according to current treatment status but do not establish whether the biological effects of proteasome inhibitors on bone remodeling translate into clinically meaningful patient-reported or structural skeletal benefits.
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BibTeX
@article{maier2026patientreported,
title = {{Patient-reported outcomes and skeletal symptoms in multiple myeloma stratified by proteasome inhibitor-based therapy: a prospective interdisciplinary cohort study.}},
author = {Julian P Maier and Carlotta Pietsch and Hagen Schmal and Ioannis Ntanasis-Stathopoulos and Evangelos Terpos and Gabriele Ihorst and Ralph Wäsch and Monika Engelhardt and Georg W Herget},
journal = {BMC cancer},
year = {2026},
month = oct,
doi = {10.1186/s12885-026-17177-7},
url = {https://europepmc.org/article/MED/42926231},
note = {CC BY},
}
RIS
TY - JOUR
TI - Patient-reported outcomes and skeletal symptoms in multiple myeloma stratified by proteasome inhibitor-based therapy: a prospective interdisciplinary cohort study.
AU - Julian P Maier
AU - Carlotta Pietsch
AU - Hagen Schmal
AU - Ioannis Ntanasis-Stathopoulos
AU - Evangelos Terpos
AU - Gabriele Ihorst
AU - Ralph Wäsch
AU - Monika Engelhardt
AU - Georg W Herget
PY - 2026
DA - 2026/10/15
JO - BMC cancer
DO - 10.1186/s12885-026-17177-7
UR - https://europepmc.org/article/MED/42926231
AB - Background Multiple myeloma (MM) frequently causes osteolytic bone disease and skeletal symptoms. Proteasome inhibitors (PIs) are central to MM treatment and in routine practice, PI-based therapy is preferentially selected for patients with more active or symptomatic disease. Hereby, PIs may also exert bone-modulating effects beyond their antimyeloma activity. Whether these biological effects are reflected in patient-reported outcomes or skeletal symptoms during routine care remains unclear.Methods We prospectively enrolled 209 patients with MM during routine interdisciplinary follow-up and stratified them by current PI-based versus non-PI-based treatment status. Sixty-nine patients were reassessed after at least 6 months. Patient-reported outcomes and skeletal symptoms were evaluated using multivariable regression and sensitivity analyses addressing baseline imbalances and treatment selection.Results Seventy-eight patients (37%) were currently receiving PI-based treatment. In adjusted analyses, current PI-based treatment status was not associated with Quality of Life (β = -0.08, 95% CI -0.45 to 0.29; p = 0.662), health-related status (β = -0.06, 95% CI -0.42 to 0.30; p = 0.740), bone pain (OR 0.92, 95% CI 0.48 to 1.74; p = 0.791), or prevalent osteolytic lesions (OR 1.26, 95% CI 0.53 to 2.96; p = 0.601). QoL and health-related status remained comparable during follow-up. MM-related bone pain was numerically more frequent among patients currently receiving PI-based treatment (46% vs. 33%), although the association did not reach statistical significance after multivariable adjustment (OR 1.80, 95% CI 0.93 to 3.48; p = 0.081).Conclusions In this prospective real-world cohort, current PI-based treatment status was not associated with measurable differences in global patient-reported outcomes, overall bone pain, or prevalent osteolytic lesions compared with non-PI-based treatment. MM-related bone pain was numerically more frequent among patients currently receiving PI-based treatment, although the association did not reach statistical significance after multivariable adjustment. These findings provide a real-world description of patient-reported and skeletal outcomes according to current treatment status but do not establish whether the biological effects of proteasome inhibitors on bone remodeling translate into clinically meaningful patient-reported or structural skeletal benefits.
SN - 1471-2407
ER -