Imaging, QoL and Patient-Reported Outcome and Supportive Care

Category: Imaging, QoL and Patient-Reported Outcome and Supportive Care

An orthopaedic-guided exercise intervention for newly diagnosed multiple myeloma patients is feasible, safe and improves patient-reported outcomes (GMMG-HD8-INDEX trial)

(PA-115) An Orthopaedic-guided Exercise Intervention for Newly Diagnosed Multiple Myeloma Patients Is Feasible, Safe and Improves Patient-reported Outcomes (GMMG-HD8-INDEX Trial)

Friday, September 19, 2025

Ulrike Dapunt, MD

Orthopaedic specialist
Internal Medicine V, GMMG-Study Group at University Hospital Heidelberg, Heidelberg, Germany

Introduction: Due to painful osteolytic bone lesions, physical exercise is often avoided in newly diagnosed multiple myeloma (NDMM) patients. Modern quadruplet-therapies have significantly improved treatment-tolerability and -effectivity, which raises the question whether long-term immobilization and functional decline are still inevitable. Aim of this study was to evaluate safety, feasibility and effectivity of an early exercise intervention.

Methods: Fifty transplant-eligible NDMM patients were included. All patients received an orthopaedic consultation. Bone instability was not defined as an exclusion criteria and patients were randomized 2:1 to an intervention group (IG) or standard of care (SOC). The IG received an exercise plan for whole body resistance training. Patients were monitored weekly via an online training-app and orthopaedic follow-up examination was conducted in every treatment cycle. Patient-reported outcomes (PRO) and functional performance (FP) were evaluated at baseline (T0), after induction therapy (T1) and after autologous stem cell transplantation(T2).

Results:

The recruitment rate was 100%, with exercise feasibility achieved in 71% and exercise protocol adherence exceeding 90% among all patients. Individual adaptation of exercise plans was necessary for 65% of patients at T0, and training intensity could be increased in 59% during treatment. Bone stability was evaluated using the Spinal Instability Neoplastic Score (SINS1 58%, SINS2 40%, SINS3 2%). In 16% of patients, weight-bearing activities were restricted or excluded due to severe instability of the lower extremities/pelvis. New vertebral fractures were detected at T2 in 21% of patients in SOC and 18% in the IG—rates consistent with expectations. One fracture of an unstable subtrochanteric femoral osteolysis occurred (unrelated to the exercise intervention), which was treated surgically and training could be resumed 10 days post-surgery. FP was limited in 40% of patients at T0 due to pain or bone instability. PROs varied widely. However, fear of movement or injury (TSK-11) and fear of falling (FES-I) showed significant improvement in the IG between T0 and both T1 and T2 (p < 0.05). Pain levels (VAS) also significantly decreased in the IG from T0 to T2 (p < 0.05). Moreover, regular use of pain medication decreased notably in the IG (from 55.5% at T0 to 12% at T2), while it increased in the SOC group (from 30% to 44%).

Conclusions: The demand for an orthopaedic consultation and subsequent exercise recommendations in NDMM patients is high, as reflected by the recruitment, feasibility and adherence rates of this exercise trial. We were able to demonstrate that an early orthopaedic-guided exercise intervention is feasible and safe, also for patients with unstable bone lesions. However, exercise protocols need to be adapted individually and regular orthopaedic follow-up visits are imperative. Our results show that painful symptoms and fear of movement and falling can be effectively addressed by an exercise intervention.