Objectives:

1. To estimate the effects of novel induction agents on reducing multiple myeloma (MM)-related symptoms and associated dynamic changes in interleukin (IL)-6. We will test the hypothesis that during induction therapy, patients with greater reduction in tumor markers (M-protein) will report greater relief of MM-related symptoms (bone pain, fatigue) related to lower serum IL-6 levels and, possibly, to reduced nuclear factor-kappa B (NF-kB) activation levels.
2. To determine the course of the development of neuropathic pain caused by induction therapy and its association with serum tumor necrosis factor (TNF)-a in treatment-naïve patients with MM. We will test the hypothesis that patients report increasingly severe neuropathy (beginning with hand and foot numbness and increasing gradually to pain) related to increasing levels of serum TNF-a.
3. To study the association between cytokines and symptom burden driven solely by MM disease in treatment-naïve patients by examining serum cytokines and symptoms prior to cancer treatment. The acquisition of such baseline knowledge is necessary to the further development and interpretation of models correlating both disease-related and treatment-driven cytokines and symptoms. We hypothesize that, controlled for host factors, preinduction serum levels of certain overexpressed proinflammatory cytokines (IL-6, TNF-a) and their upstream marker NF-kB and product (C-reactive protein [CRP]) will directly relate to elevated severity of MM-related symptoms (bone pain and fatigue) in treatment-naïve patients.
4. To study multiple symptom development in acute phase of autologous stem cell transplantation (auto-SCT) for MM patients, and the symptom severity related level of serum inflammatory cytokines (Mainly IL-6). We hypothesize that, nadir related symptom burden is associated with significant increase of pro inflammatory cytokines (IL-6 as domain) that caused by pretransplant chemotherapy, conditioning and the stem cell transplant.
5. To track primary afferent function by quantitative sensory testing over time during chemotherapy in patients with MM. We hypothesize that patients being treated with novel agents and who develop neurosensory changes will exhibit reduction in primary afferent fiber function as reflected in the sensory testing measures.
6. To characterize neurocognitive and neuropsychiatric symptoms in patients with MM using a neuropsychological test battery at baseline and every 3 months thereafter and at off-study. We hypothesize that approximately one third of patients with MM will develop impairments of memory, executive function, and fine-motor speed during and after cancer treatment.