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Chai KL, Wellard C, Thao LTP, Aoki N, Moore EM, Augustson BM, Bapat A, Blacklock H, Chng WJ, Cooke R, Forsyth CJ, Goh Y, Hamad N, Harrison SJ, Ho PJ, Hocking J, Kerridge I, Kim JS, Kim K, King T, McCaughan GJ, Mollee P, Morrissey CO, Murphy N, Quach H, Tan XN, Tso ACY, Wong KSQ, Yoon S, Spencer A, Wood EM, McQuilten ZK. Variation in immunoglobulin use and impact on survival in myeloma. EJHAEM 2024; 5:690-697. [PMID: 39157592 PMCID: PMC11327709 DOI: 10.1002/jha2.938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 08/20/2024]
Abstract
Serious infection is common in patients with multiple myeloma due to immune deficiency from the underlying disease and/or its treatment. Immunoglobulin replacement is one approach to reduce infection risk in these patients. However, few real-world data exist on its use in patients with myeloma. We investigated immunoglobulin use in Australia, New Zealand and Asia-Pacific using registry data and explored its association with survival outcomes. A total of 2374 patients with a median follow-up time of 29.5 months (interquartile range 13.3-54.3 months) were included in the analysis - 1673 from Australia, 313 Korea, 281 New Zealand and 107 Singapore. Overall, 7.1% of participants received immunoglobulin replacement within 24 months of diagnosis. Patients who received immunoglobulin replacement were likely to be younger, had lower baseline IgG levels (excluding paraprotein), were more likely to have baseline hypogammaglobulinaemia, baseline severe hypogammaglobulinaemia and abnormal baseline fluorescent in-situ hybridisation status, receive first-line myeloma treatment with immunomodulatory drugs or anti-CD38 therapy and undergo upfront autologous stem cell transplant. In our patient cohort, the use of immunoglobulin was not associated with overall survival benefit at the time of last follow-up (adjusted hazard ratio 0.72, 95% CI 0.46-1.14, p = 0.16). Understanding treatment approaches in clinical practice can help support future planning and provision of immunoglobulin resources.
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Affiliation(s)
- Khai Li Chai
- Transfusion Research UnitSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Cameron Wellard
- Transfusion Research UnitSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - LTP Thao
- Transfusion Research UnitSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Naomi Aoki
- Transfusion Research UnitSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Elizabeth M Moore
- Transfusion Research UnitSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | | | - Akshay Bapat
- Department of HaematologyRoyal Hobart HospitalHobartAustralia
| | | | - Wee J Chng
- Department of Haematology‐Oncology and Cancer Science Institute of SingaporeNational University Cancer InstituteSingaporeSingapore
| | - Rachel Cooke
- Department of HaematologyNorthern HospitalMelbourneAustralia
| | | | - Yeow‐Tee Goh
- Department of HaematologySingapore General HospitalSingaporeSingapore
| | - Nada Hamad
- Department of HaematologySt Vincent's Hospital SydneySydneyAustralia
- St Vincent's Clinical SchoolUniversity of New South WalesSydneyAustralia
- School of MedicineUniversity of Notre DameSydneyAustralia
| | - Simon J Harrison
- Department of HaematologyPeter MacCallum Cancer Centre and the Royal Melbourne HospitalMelbourneAustralia
| | - P Joy Ho
- Department of HaematologyRoyal Prince Alfred HospitalSydneyAustralia
| | - Jay Hocking
- Department of HaematologyBox Hill HospitalMelbourneAustralia
| | - Ian Kerridge
- Department of HaematologyRoyal North Shore HospitalSydneyAustralia
| | - Jin Seok Kim
- Department of Internal MedicineDivision of HaematologyYonsei University College of MedicineSeverance HospitalSeoulSouth Korea
| | - Kihyun Kim
- Department of MedicineDivision of Haematology‐OncologySungkyunkwan University School of MedicineSamsung Medical CenterSeoulSouth Korea
| | - Tracy King
- Department of HaematologyRoyal Prince Alfred HospitalSydneyAustralia
| | - Georgia J McCaughan
- Department of HaematologySt Vincent's Hospital SydneySydneyAustralia
- St Vincent's Clinical SchoolUniversity of New South WalesSydneyAustralia
| | - Peter Mollee
- Department of HaematologyPrincess Alexandra HospitalBrisbaneAustralia
| | - C Orla Morrissey
- Department of Infectious DiseasesThe Alfred Hospital and Monash UniversityMelbourneAustralia
| | - Nick Murphy
- Department of HaematologyRoyal Hobart HospitalHobartAustralia
| | - Hang Quach
- Department of HaematologySt Vincent's Hospital MelbourneMelbourneAustralia
- Medicine, Dentistry and Health SciencesThe University of MelbourneMelbourneAustralia
| | - Xuan Ni Tan
- Department of HaematologySir Charles Gairdner HospitalPerthAustralia
| | - Allison CY Tso
- Department of HaematologyTan Tock Seng HospitalSingaporeSingapore
| | | | - Sung‐Soo Yoon
- Division of Haematology/Medical OncologySeoul National University HospitalSeoulSouth Korea
| | - Andrew Spencer
- Department of HaematologyThe Alfred HospitalMelbourneAustralia
| | - Erica M Wood
- Transfusion Research UnitSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
- Department of HaematologyMonash HealthMelbourneAustralia
| | - Zoe K McQuilten
- Transfusion Research UnitSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
- Department of HaematologyThe Alfred HospitalMelbourneAustralia
- Department of HaematologyMonash HealthMelbourneAustralia
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2
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Abonour R, Lee HC, Rifkin R, Ailawadhi S, Omel J, Hardin JW, Narang M, Toomey K, Gasparetto C, Wagner LI, Terebelo H, Mouro J, Dhanasiri S, Liu L, Yu E, Jagannath S. The Effect of Age and Other Patient Characteristics on Outcomes Among Nontransplanted Patients Who Were Treated With First-Line Lenalidomide, Bortezomib, and Dexamethasone: Results From the Connect Ⓡ MM Registry. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00225-8. [PMID: 39033038 DOI: 10.1016/j.clml.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/03/2024] [Accepted: 05/29/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Lenalidomide (R), bortezomib (V), and dexamethasone (d) is a standard-of-care regimen in newly diagnosed multiple myeloma (NDMM); however, characteristics and outcomes for nontransplanted patients receiving frontline RVd are not well understood. PATIENTS The ConnectⓇ MM Registry is a large, US, multicenter, prospective observational cohort study of NDMM patients. METHODS This analysis investigated characteristics and outcomes of patients who received RVd alone or followed by Rd or R (RVd ± Rd/R) who did not undergo frontline autologous stem cell transplantation. RESULTS As of August 2021, 314 of 1979 nontransplanted patients received RVd ± Rd/R as initial therapy. Of these, 135 were aged ≤ 65 years and 179 were > 65 years. 108 patients had time to relapse (TTR) of ≤ 12 months and 182 had TTR > 12 months. Baseline characteristics were comparable regardless of TTR and age group except renal function, which was more commonly impaired in older patients. Among patients aged ≤ 65 and > 65 years, median duration of first-line treatment was 6.3 and 9.0 months, median time to next line for those who received second-line therapy was 15.5 and 15.2 months, median progression-free survival (PFS) was 19.3 and 23.0 months, and median overall survival was 60.0 and 59.1 months, respectively. High-risk disease (per IMWG criteria) and high serum calcium were associated with higher hazard of progression or death; the adjusted PFS hazard ratio with respect to age (≤ 65 vs. > 65 years) based on multivariable analysis was 1.18 (0.89-1.57; P = .25). CONCLUSION These results indicate RVd is active across age groups and provide a better understanding of outcomes with RVd in NDMM.
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Affiliation(s)
- Rafat Abonour
- Department of Medicine, Division of Hematology/Oncology, Indiana University, Indianapolis, IN.
| | - Hans C Lee
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert Rifkin
- Rocky Mountain Cancer Centers US Oncology, Denver, CO
| | | | - James Omel
- Myeloma Research Advocate/Advisor, Grand Island, NE
| | - James W Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - Mohit Narang
- Maryland Oncology Hematology, US Oncology Research, Columbia, MD
| | | | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC
| | - Lynne I Wagner
- Department of Health Policy and Management, UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Jorge Mouro
- Celgene International Sàrl, a Bristol Myers Squibb Company, Boudry, Switzerland
| | - Sujith Dhanasiri
- Celgene International Sàrl, a Bristol Myers Squibb Company, Boudry, Switzerland
| | | | | | - Sundar Jagannath
- Department of Medicine, Hematology and Medical Oncology, Mount Sinai Hospital, New York, NY
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3
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Charalampous C, Goel U, Kapoor P, Binder M, Buadi F, Dingli D, Dispenzieri A, Fonder A, Gertz M, Gonsalves W, Hayman S, Hobbs M, Hwa YL, Kourelis T, Lacy M, Leung N, Lin Y, Warsame R, Kyle RA, Rajkumar V, Kumar SK. Association of Thrombocytopenia With Disease Burden, High-Risk Cytogenetics, and Survival in Newly Diagnosed Multiple Myeloma Patients Treated With Novel Therapies. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00224-6. [PMID: 38955580 DOI: 10.1016/j.clml.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/29/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND The effect of thrombocytopenia has not been studied in the era of novel treatments in multiple myeloma (MM). OBJECTIVE To evaluate the clinical characteristics and outcomes in MM patients presenting with thrombocytopenia. MATERIALS Newly diagnosed MM patients between 2008 and 2018 who received at least 2 novel agents at induction. Thrombocytopenia was defined as a platelet count of less than < 150,000/mm3. RESULTS A total of 648 patients were identified. Thrombocytopenia was found in 120 patients (18.5%). Baseline disease characteristics associated with higher rates of thrombocytopenia at baseline included IgA myeloma, P < .01, ISS 3 versus 1 or 2, P < .01, R-ISS 3 versus 1 or 2, P < .01, renal failure (CrCl < 30 mL/min), P < .01, hypercalcemia (Ca > 11.5 mg/dL), P < .01, elevated LDH, P < .03, anemia (Hb < 10 g/dL), P < .01, higher serum monoclonal protein, P < .02, and > 60% plasma cells in the bone marrow, P < .01. Thrombocytopenia was more prevalent across patients with t(4;14) and t(14;16), but was not associated with an overall high-risk fluorescence in situ hybridization (FISH) classification. Median OS was significantly lower among patients with thrombocytopenia (64.4 vs. 145.0 months, P < .01). In multivariable Cox regression, thrombocytopenia was associated with mortality (HR = 2.45, 95% CI, 1.7-3.6) independently of age, sex, high-risk FISH, ISS stage, response at induction, percentage of plasma cells in the BM, and anemia. CONCLUSION We found that thrombocytopenia was seen among one-fifth of MM patients and was more common in patients with (t[4; 14] and t[14; 16]). Thrombocytopenia had an independent association with worse survival.
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Affiliation(s)
| | - Utkarsh Goel
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Prashant Kapoor
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Moritz Binder
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Francis Buadi
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - David Dingli
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Angela Dispenzieri
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Amie Fonder
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Morie Gertz
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Wilson Gonsalves
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Suzanne Hayman
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Miriam Hobbs
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Yi Lisa Hwa
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Taxiarchis Kourelis
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Martha Lacy
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Nelson Leung
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Yi Lin
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Rahma Warsame
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Robert A Kyle
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Vincent Rajkumar
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Shaji K Kumar
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN.
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Seefat MR, Cucchi DGJ, Groen K, Donker ML, van der Hem KG, Westerman M, Gerrits AM, Beeker A, van de Donk NWCJ, Blommestein HM, Zweegman S. Treatment sequences and drug costs from diagnosis to death in multiple myeloma. Eur J Haematol 2024; 112:360-366. [PMID: 37821211 DOI: 10.1111/ejh.14119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023]
Abstract
Novel therapies for multiple myeloma (MM) have improved patient survival, but their high costs strain healthcare budgets. End-of-life phases of treatment are generally the most expensive, however, these high costs may be less justifiable in the context of a less pronounced clinical benefit. To manage drug expenses effectively, detailed information on end-of-life drug administration and costs are crucial. In this retrospective study, we analysed treatment sequences and drug costs from 96 MM patients in the Netherlands who died between January 2017 and July 2019. Patients received up to 16 lines of therapy (median overall survival: 56.5 months), with average lifetime costs of €209 871 (€3111/month; range: €3942-€776 185) for anti-MM drugs. About 85% of patients received anti-MM treatment in the last 3 months before death, incurring costs of €20 761 (range: €70-€50 122; 10% of total). Half of the patients received anti-MM treatment in the last 14 days, mainly fully oral regimens (66%). End-of-life treatment costs are substantial despite limited survival benefits. The use of expensive treatment options is expected to increase costs further. These data serve as a reference point for future cost studies, and further research is needed to identify factors predicting the efficacy and clinical benefit of continuing end-of-life therapy.
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Affiliation(s)
- M R Seefat
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - D G J Cucchi
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - K Groen
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - M L Donker
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - K G van der Hem
- Department of Internal Medicine, Zaandam Medical Center, Zaandam, The Netherlands
| | - M Westerman
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - A M Gerrits
- Department of Internal Medicine, OLVG, Amsterdam, The Netherlands
| | - A Beeker
- Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - N W C J van de Donk
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - H M Blommestein
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - S Zweegman
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
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5
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Mai EK, Hielscher T, Bertsch U, Salwender HJ, Zweegman S, Raab MS, Munder M, Pantani L, Mancuso K, Brossart P, Beksac M, Blau IW, Dürig J, Besemer B, Fenk R, Reimer P, van der Holt B, Hänel M, von Metzler I, Graeven U, Müller-Tidow C, Boccadoro M, Scheid C, Dimopoulos MA, Hillengass J, Weisel KC, Cavo M, Sonneveld P, Goldschmidt H. Predictors of early morbidity and mortality in newly diagnosed multiple myeloma: data from five randomized, controlled, phase III trials in 3700 patients. Leukemia 2024; 38:640-647. [PMID: 38062124 PMCID: PMC10912032 DOI: 10.1038/s41375-023-02105-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 01/10/2024]
Abstract
Early morbidity and mortality affect patient outcomes in multiple myeloma. Thus, we dissected the incidence and causes of morbidity/mortality during induction therapy (IT) for newly diagnosed multiple myeloma (NDMM), and developed/validated a predictive risk score. We evaluated 3700 transplant-eligible NDMM patients treated in 2005-2020 with novel agent-based triplet/quadruplet IT. Primary endpoints were severe infections, death, or a combination of both. Patients were divided in a training (n = 1333) and three validation cohorts (n = 2367). During IT, 11.8%, 1.8%, and 12.5% of patients in the training cohort experienced severe infections, death, or both, respectively. Four major, baseline risk factors for severe infection/death were identified: low platelet count (<150/nL), ISS III, higher WHO performance status (>1), and age (>60 years). A risk score (1 risk factor=1 point) stratified patients in low (39.5%; 0 points), intermediate (41.9%; 1 point), and high (18.6%; ≥2 points) risk. The risk for severe infection/death increased from 7.7% vs. 11.5% vs. 23.3% in the low- vs. intermediate- vs. high-risk groups (p < 0.001). The risk score was independently validated in three trials incorporating quadruplet IT with an anti-CD38 antibody. Our analyses established a robust and easy-to-use score to identify NDMM patients at risk of severe infection/death, covering the latest quadruplet induction therapies. Trial registrations: HOVON-65/GMMG-HD4: EudraCT No. 2004-000944-26. GMMG-MM5: EudraCT No. 2010-019173-16. GMMG-HD6: NCT02495922. EMN02/HOVON-95: NCT01208766. GMMG-HD7: NCT03617731.
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Affiliation(s)
- Elias K Mai
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany.
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Uta Bertsch
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Hans J Salwender
- Tumorzentrum Asklepios Hamburg, AK Altona and AK St. Georg, Hamburg, Germany
| | - Sonja Zweegman
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Marc S Raab
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Munder
- Department of Internal Medicine III, University Medical Center Mainz, Mainz, Germany
| | - Lucia Pantani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy
| | - Katia Mancuso
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy
| | - Peter Brossart
- Department of Internal Medicine III, University Hospital Bonn, Bonn, Germany
| | - Meral Beksac
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - Igor W Blau
- Medical Clinic, Charité University Medicine Berlin, Berlin, Germany
| | - Jan Dürig
- Department of Hematology, University Clinic Essen, Essen, Germany
| | - Britta Besemer
- Department of Hematology, Oncology and Immunology, University Hospital Tübingen, Tübingen, Germany
| | - Roland Fenk
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Peter Reimer
- Klinik für Hämatologie, Evangelische Kliniken Essen Mitte, Evangelisches Krankenhaus Essen-Werden, Essen, Germany
| | - Bronno van der Holt
- HOVON Data Center, Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Mathias Hänel
- Department of Internal Medicine III, Klinikum Chemnitz, Chemnitz, Germany
| | - Ivana von Metzler
- Medical Clinic II, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Ullrich Graeven
- Department of Internal Medicine I, Hospital Maria Hilf GmbH, Mönchengladbach, Germany
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Christof Scheid
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Katja C Weisel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michele Cavo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
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6
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Khadka S, Balaji S, Kaur J, Solanki D, Kasianchyk M, Chowdhury H, Patel I, Qasim M, Desai M, Maiyani P, Moradiya DV, Lal D, Patel AA, Lekkala M. Disparities in Outcomes of Hospitalizations Due to Multiple Myeloma: A Nationwide Comparison. Cureus 2023; 15:e47319. [PMID: 38022254 PMCID: PMC10656933 DOI: 10.7759/cureus.47319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Background With the advent of novel treatments, there is a declining trend in the multiple myeloma (MM) mortality rate with an increasing hospitalization rate. However, there is limited population-based data on trends and outcomes of hospitalizations due to MM in the United States (US). Methods We analyzed the publicly available Nationwide Inpatient Sample (NIS) from 2007 to 2017 to identify MM hospitalizations. Results Hospitalizations for MM increased from 17,100 (8.71%) in 2007 to 19,490 (9.92%) in 2017. The in-hospital mortality rate declined from 8.4% in 2007 to 4.9% in 2017 (P <0.001) and discharge to facilities decreased from 20.4% in 2007 to 17.4% in 2017 (P <0.001). The odds of in-hospital mortality were higher with increasing age (odds ratio (OR): 1.46; 95% confidence interval (CI): 1.38 -1.54; P <0.0001), pneumonia (OR: 4.18; 95% CI: 3.63 - 4.81, P <0.0001), septicemia (OR: 2.50; 95% CI: 2.22 - 2.82; P <0.0001), renal failure (OR: 1.48; 95% CI: 1.34 -1.64; P <0.0001), uninsured/self-pay insurance status (OR: 2.69; 95% CI: 2.18 - 3.3; P <0.0001), rural hospital (OR: 2.26; 95% CI: 1.88 -2.72; P<0.0001), and urban-non-teaching hospitals (OR: 1.38; 95% CI: 1.23 - 1.56; P <0.0001). Also, increasing age (OR: 1.14; 95% CI: 1.11-1.18, P <0.0001), Black race (OR: 1.12; 95% CI: 1.02-1.23, P <0.0001), and multiple comorbidities were associated with higher disability. Conclusion Hospitalizations for MM continued to increase, whereas in-hospital mortality continued to decrease. Advanced age, sepsis, pneumonia, and renal failure were associated with higher odds of mortality in MM patients.
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Affiliation(s)
- Sushmita Khadka
- Internal Medicine, Guthrie Robert Packer Hospital, Sayre, USA
| | - Swetha Balaji
- Medicine, Scripps Clinic John R. Anderson V Medical Pavilion, San Diego, USA
| | - Japjeet Kaur
- Medicine, Sub-divisional Civil Hospital, Ajnala, IND
| | | | | | | | - Ishani Patel
- Medicine, Houston Medical Center, Warner Robins, USA
| | - Muhammad Qasim
- Internal Medicine, Hospital Corporation of America (HCA) Healthcare/University of South Florida (USF) Morsani College of Medicine Graduate Medical Education (GME) Oak Hill Hospital, Brooksville, USA
| | - Maheshkumar Desai
- Internal Medicine, Hamilton Medical Center, Medical College of Georgia/Augusta University, Dalton, USA
| | - Prakash Maiyani
- Internal Medicine, Gold Coast University Hospital, Southport, AUS
| | | | - Darshan Lal
- Hospital Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Achint A Patel
- Internal Medicine, Hospital Corporation of America (HCA) Healthcare/University of South Florida (USF) Morsani College of Medicine Graduate Medical Education (GME) Oak Hill Hospital, Brooksville, USA
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7
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Grant SJ, Wildes TM, Rosko AE, Silberstein J, Giri S. A real-world data analysis of predictors of early mortality after a diagnosis of multiple myeloma. Cancer 2023; 129:2023-2034. [PMID: 36989073 PMCID: PMC10330042 DOI: 10.1002/cncr.34760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/21/2023] [Accepted: 02/24/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Despite the increased availability and use of novel therapies for multiple myeloma, early mortality is a pervasive challenge with a significant impact on older adults. Reported rates and predictors of early mortality have varied in the literature, with most studies seldom focusing on community-treated patients. METHODS In this retrospective cohort analysis of a real-world electronic health record-derived deidentified database of 7512 patients newly diagnosed with multiple myeloma between January 1, 2011, and February 2, 2021, and treated primarily in US-based community oncology practices, factors associated with early mortality (defined as death within 6 months after the multiple myeloma diagnosis) were examined with the use of binary logistic regression. RESULTS The median age was 70 years overall. We found an overall early mortality rate of 8.3%, with 73% of early deaths occurring in those aged ≥70 years. Among the early deaths, only 49 patients (8.7%) had documented disease progression before death (median time to progression, 30 days [interquartile range, 7-53 days]). Baseline factors associated with higher odds of early mortality included an Eastern Cooperative Oncology Group performance status (ECOG PS) ≥ 2, Revised International Staging System (R-ISS) stage III, an age ≥ 70 years, receipt of proteasome inhibitor-doublet therapy, a light-chain isotype, and the presence of renal dysfunction (estimated glomerular filtration rate < 30 mL/min). Among those aged ≥70 years, ECOG PS ≥ 2 and R-ISS stage III remained the strongest predictors of early mortality. CONCLUSIONS Early mortality disproportionately affects older adults (aged ≥70 years) with multiple myeloma. Interventions to support this population are needed to reduce disparate survival outcomes. PLAIN LANGUAGE SUMMARY Factors associated with an increased risk of dying within 6 months (early mortality) of a new diagnosis of multiple myeloma (MM) among 7512 mostly community-treated patients with MM were evaluated. The early mortality rate was 8.3%; among those deaths, 49 patients (8.7%) had documented evidence of MM progression before death. The risk of early mortality was greatest for older patients (aged ≥70 years) and those with a poor performance status, poor kidney function, a higher disease stage, and light-chain MM and those receiving two-drug MM therapies. These findings highlight the need for supportive interventions geared toward older adults with MM.
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Affiliation(s)
- Shakira J. Grant
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tanya M. Wildes
- Division of Hematology/Oncology, University of Nebraska Medical Center/Nebraska Medicine, Omaha NE
| | - Ashley E. Rosko
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH
| | - Juliet Silberstein
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Smith Giri
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL
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Lu X, Liu W, Zhang L, Chen X, Yang L, Yao Q, Zhao J, He S, Wei J, Tian W. Eastern Cooperative Oncology Group, β2-microglobulin, hemoglobin, and lactate dehydrogenase can predict early grade ≥ 3 infection in patients with newly diagnosed multiple myeloma: A real-world multicenter study. Front Microbiol 2023; 14:1114972. [PMID: 36778870 PMCID: PMC9911534 DOI: 10.3389/fmicb.2023.1114972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/03/2023] [Indexed: 01/28/2023] Open
Abstract
Introduction This research explored the clinical application of grade ≥ 3 infection predictive models for the newly diagnosed multiple myeloma (NDMM) population. Methods It evaluated 306 patients with NDMM based on three different predictive models. The relationship between the grade ≥ 3 infection rates in NDMM and the scores was analyzed retrospectively. The cumulative incidence of early grade ≥ 3 infection was estimated using the Kaplan-Meier method and log-rank test to assess the statistical significance of the difference. To compare the predictive performance in the prediction of infection, the Receiver Operating Characteristic Curve (ROC) curve was used to show the area under the curve (AUC), and DeLong's test was used to analyze the difference in AUC. Results The incidence of grade ≥ 3 infection within the first 4 months of NDMM was 40.20%. Concerning the FIRST score (predictors: ECOG, β2-microglobulin, hemoglobin, and lactate dehydrogenase), GEM-PETHEMA score (predictors: albumin, male sex, ECOG, and non-IgA type MM), and Infection Risk model of Multiple Myeloma (IRMM) score (predictors: ECOG, serum β2-microglobulin, globulin, and hemoglobin), the probability of early grade ≥ 3 infection in the different groups showed statistically significant differences (low-risk vs. high-risk: 25.81% vs. 50.00%, p < 0.001; low-risk vs. moderate-risk vs. high-risk: 35.93% vs. 41.28% vs. 60.00%, p= 0.045; low-risk vs. moderate-risk vs. high-risk: 20.00% vs. 43.75% vs. 52.04%, p < 0.001). Statistical differences existed in the probability of early grade ≥ 3 infection among the different groups by the FIRST and IRMM scores but no statistical differences in the GEM-PETHEMA score (p < 0.001, p< 0.001, and p = 0.090, respectively). The FIRST score showed good discrimination and simple calculation with highest AUC. Further subgroup analysis showed that the FIRST score could still apply for patients treated with bortezomib-based regimen and frail patients. Discussion Our findings indicate that the FIRST score (consisting of ECOG, β2-microglobulin, hemoglobin, and lactate dehydrogenase) is a simple and robust infection stratification tool for patients with NDMM and could be used in routine clinical work.
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Affiliation(s)
- Xinyi Lu
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan, Shanxi, China
| | - Wenhua Liu
- Department of Hematology, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China
| | - Lan Zhang
- Department of Hematology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xinyue Chen
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan, Shanxi, China
| | - Liping Yang
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan, Shanxi, China
| | - Qiong Yao
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan, Shanxi, China
| | - Jie Zhao
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan, Shanxi, China
| | - Shaolong He
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan, Shanxi, China
| | - Jia Wei
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan, Shanxi, China,Sino-German Joint Oncological Research Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, Shanxi, China,Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,*Correspondence: Jia Wei, ✉
| | - Weiwei Tian
- Department of Hematology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan, Shanxi, China,Sino-German Joint Oncological Research Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, Shanxi, China,Weiwei Tian, ✉
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Intestinal Klebsiella pneumoniae Contributes to Pneumonia by Synthesizing Glutamine in Multiple Myeloma. Cancers (Basel) 2022; 14:cancers14174188. [PMID: 36077725 PMCID: PMC9454521 DOI: 10.3390/cancers14174188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Pneumonia accounts for a significant cause of morbidity and mortality in multiple myeloma (MM) patients. It has been previously shown that intestinal Klebsiella pneumonia (K. pneumonia) enriches in MM and promotes MM progression. However, what role the altered gut microbiota plays in MM with pneumonia remains unknown. Here, we show that intestinal K. pneumonia is significantly enriched in MM with pneumonia. This enriched intestinal K. pneumonia links to the incidence of pneumonia in MM, and intestinal colonization of K. pneumonia contributes to pneumonia in a 5TGM1 MM mice model. Further targeted metabolomic assays reveal the elevated level of glutamine, which is consistently increased with the enrichment of K. pneumonia in MM mice and patients, is synthesized by K. pneumonia, and leads to the elevated secretion of TNF-α in the lung normal fibroblast cells for the higher incidence of pneumonia. Inhibiting glutamine synthesis by establishing glnA-mutated K. pneumonia alleviates the incidence of pneumonia in the 5TGM1 MM mice model. Overall, our work proposes that intestinal K. pneumonia indirectly contributes to pneumonia in MM by synthesizing glutamine. Altogether, we unveil a gut–lung axis in MM with pneumonia and establish a novel mechanism and a possible intervention strategy for MM with pneumonia.
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Establishment and Validation for Predicting the Death of Multiple Myeloma among Whites. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3050199. [PMID: 36016680 PMCID: PMC9398791 DOI: 10.1155/2022/3050199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/16/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022]
Abstract
The prognosis of multiple myeloma (MM) patients was poor in white-American patients as compared to black-American patients. This study aimed to predict the death of MM patients in whites based on the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. A total of 28,912 white MM patients were included in this study. Data were randomly divided into a training set and a test set (7 : 3). The random forest and 5-fold cross-validation were used for developing a prediction model. The performance of the model was determined by calculating the area under the curve (AUC) with 95% confidence interval (CI). MM patients in the death group had older age, higher proportion of tumor distant metastasis, bone marrow as the disease site, receiving radiotherapy, and lower proportion of receiving chemotherapy than that in the survival group (all P < 0.001). The AUC of the random forest model in the training set and testing set was 0.741 (95% CI, 0.740–0.741) and 0.703 (95% CI, 0.703–0.704), respectively. In addition, the AUC of the age-based model was 0.688 (95% CI, 0.688–0.689) in the testing set. The results of the DeLong test indicated that the random forest model had better predictive effect than the age-based model (Z = 7.023, P < 0.001). Further validation was performed based on age and marital status. The results presented that the random forest model was robust in different age and marital status. The random forest model had a good performance to predict the death risk of MM patients in whites.
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McQuilten Z, Wellard C, Moore E, Augustson B, Bergin K, Blacklock H, Harrison S, Ho PJ, King T, Quach H, Mollee P, Rosengarten B, Walker P, Wood E, Spencer A. Predictors of early mortality in multiple myeloma: Results from the Australian and New Zealand Myeloma and Related Diseases Registry (MRDR). Br J Haematol 2022; 198:830-837. [PMID: 35818641 PMCID: PMC9541953 DOI: 10.1111/bjh.18324] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 11/29/2022]
Abstract
The frequency and causes of early mortality in patients with newly diagnosed multiple myeloma (NDMM) have not been well described in the era of novel agents. We investigated early mortality in a prospective cohort study of all patients with NDMM registered on the Australian and New Zealand Myeloma and Related Diseases Registry (MRDR) at 36 institutions between July 2011 and March 2020. Early mortality was defined as death from any cause within the first 12 months after diagnosis. A total of 2377 patients with NDMM were included in the analysis, with a median (interquartile range) age of 67.4 (58.9–74.60 years, and 60% were male. Overall, 216 (9.1%) patients died within 12 months, with 119 (4.5%) having died within 6 months. Variables that were independent predictors of early mortality after adjustment in multivariable regression included age (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.05–1.08; p < 0.001), Eastern Cooperative Oncology Group performance status (OR 1.50, 95% CI 1.26–1.79; p < 0.001), serum albumin (OR 0.95, 95% CI 0.93–0.98; p < 0.001), cardiac disease (OR 1.96, 95% CI 1.35–2.86; p < 0.001) and International Staging System (OR 1.40, 95% CI 1.07–1.82; p = 0.01). For those with a primary cause of death available, it was reported as disease‐related in 151 (78%), infection 13 (7%), other 29 (15%). Infection was listed as a contributing factor for death in 38% of patients.
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Affiliation(s)
- Zoe McQuilten
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cameron Wellard
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Elizabeth Moore
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | | | - Simon Harrison
- Peter MacCallum Cancer Centre/Royal Melbourne Hospital, Melbourne, Australia
| | - P Joy Ho
- Royal Prince Alfred Hospital, Sydney, Australia
| | - Tracy King
- Royal Prince Alfred Hospital, Sydney, Australia
| | - Hang Quach
- St.Vincent's Hospital, Melbourne, Australia
| | - Peter Mollee
- Princess Alexandra Hospital and University of Queensland, Brisbane, Australia
| | | | | | - Erica Wood
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Consensus guidelines and recommendations for infection prevention in multiple myeloma: a report from the International Myeloma Working Group. Lancet Haematol 2022; 9:e143-e161. [DOI: 10.1016/s2352-3026(21)00283-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/26/2021] [Accepted: 09/07/2021] [Indexed: 12/14/2022]
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13
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Decrease in early mortality for newly diagnosed multiple myeloma patients in the Netherlands: a population-based study. Blood Cancer J 2021; 11:178. [PMID: 34764237 PMCID: PMC8586330 DOI: 10.1038/s41408-021-00571-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 11/14/2022] Open
Abstract
Identification of risk factors for early mortality (EM) in multiple myeloma (MM) patients may contribute to different therapeutic approaches in patients at risk for EM. This population-based study aimed to assess trends in EM and risk factors for EM among MM patients diagnosed in the Netherlands. All MM patients, newly diagnosed between 1989 and 2018, were identified in the Netherlands Cancer Registry. Patients were categorized into three calendar periods (1989–1998, 1999–2008, 2009–2018) and into five age groups (≤65, 66–70, 71–75, 76–80, >80 years). EM was defined as death by any cause ≤180 days post-diagnosis. We included 28,328 MM patients (median age 70 years; 55% males). EM decreased from 22% for patients diagnosed in 1989–1998 to 13% for patients diagnosed in 2009–2018 (P < 0.01) and this decrease was observed among all age groups. Exact causes of death could not be elucidated. Besides patient’s age, we found that features related to a more aggressive disease presentation, and patient characteristics reflecting patients’ physical condition were predictive of EM. In summary, EM decreased from 1999 onwards. Nevertheless, EM remains high, especially for patients aged >70 years. Therefore, novel strategies should be explored to improve the outcome of patients at risk for EM.
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14
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Tian MR, Yang PY, Yue TT, Li MY, Zhang YJ, Zhang MX, Zhang LM, Yan YR, Hu ZL, Du YZ, Li YY, Jin FY. [A predictive model based on risk factors for early mortality in patients with newly diagnosed multiple myeloma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:666-672. [PMID: 34547873 PMCID: PMC8501273 DOI: 10.3760/cma.j.issn.0253-2727.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Indexed: 11/09/2022]
Abstract
Objective: To investigate risk factors for early mortality (EM) in patients with newly diagnosed multiple myeloma (NDMM) and to build an EM-predictive model. Methods: In a cohort of 275 patients with NDMM, risk factors for EM at 6, 12, and 24 months after diagnosis (EM6, EM12, and EM24, respectively) were determined to establish a model to predict EM. Results: The rates of EM6, EM12, and EM24 were 5.5% , 12.7% , and 30.2% , respectively. The most common cause for EM was disease progression/relapse, accounting for 60.0% , 77.1% , and 84.3% of EM6, EM12, and EM24, respectively. EM6 was associated with corrected serum calcium >2.75 mmol/L and platelet count <100×10(9)/L, whereas risk factors for EM12 included age >75 years, ISS Ⅲ, R-ISS Ⅲ, corrected serum calcium >2.75 mmol/L, serum creatinine >177 µmol/L, platelet count <100×10(9)/L, and bone marrow plasma cell ratio ≥ 60% . In addition to the risk factors for EM12, EM24 was also associated with male sex and 1q21 gain. By multivariate analysis, age >75 years, platelet count <100×10(9)/L, and 1q21 gain were independent risk factors for EM24 but there were no independent risk factors significantly associated with EM6 and EM12. Using a scoring system including these three risk factors, a Cox model for EM24 was generated to distinguish patients with low (score<3) and high (score ≥ 3) risk. The sensitivity and specificity of the model were 20.7% and 99.2% , respectively. Further, an internal validation performed in a cohort of 183 patients with NDMM revealed that the probability of EM24 in high-risk patients was 26 times higher than that in low-risk patients. Moreover, this model was also able to predict overall survival. The median overall survival of patients with scores of 0, 1, 2, 3, 4, and 5 were 59, 41, 22, 17.5, and 16 months, respectively. Conclusion: In the study cohort, the EM6, EM12, and EM24 rates were 5.5% , 12.7% , and 30.2% , respectively, and disease progression or relapse were main causes of EM. An EM24-predictive model built on three independent risk factors for EM24 (age>75 years, platelet count<100×10(9)/L, and 1q21 gain) might predict EM risk and overall survival.
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Affiliation(s)
- M R Tian
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - P Y Yang
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - T T Yue
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - M Y Li
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - Y J Zhang
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - M X Zhang
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - L M Zhang
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - Y R Yan
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - Z L Hu
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - Y Z Du
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - Y Y Li
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - F Y Jin
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
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Lin ZS, Zhang X, Yu XJ, Wang S, Wang SX, Dong YJ, Zhou FD, Zhao MH. Crystalline appearance in light chain cast nephropathy is associated with higher early mortality in patients with newly diagnosed multiple myeloma. Int Immunopharmacol 2021; 98:107875. [PMID: 34146864 DOI: 10.1016/j.intimp.2021.107875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/26/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Light chain cast nephropathy (LCCN) is the most common kidney lesion in multiple myeloma patients. LCCN may exhibit a crystalline appearance. The frequency and clinical significance of crystalline LCCN are not well understood. Here, we report the first retrospective study of crystalline LCCN. METHODS Twenty-six patients with LCCN were enrolled. We studied the clinicopathological features and outcomes of LCCN patients and compared ordinary LCCN patients (n = 18) with crystalline LCCN patients (n = 8). RESULTS Crystalline LCCN was not rare (8/26, 30.8%) in our study. The median age of LCCN patients was 57.5 (range, 41-75) years. No patients presented with nephrotic syndrome. No significant differences in clinical features were observed between the two groups. All crystalline LCCN patients suffered from advanced multiple myeloma and acute kidney injury. There was a dominance of the λ isotype (7/8, 87.5%) in patients with crystalline LCCN. Patients with ordinary LCCN had significantly higher scores of tubular atrophy and acute tubular injury than those with crystalline LCCN. The crystalline casts of 5 crystalline LCCN patients stained negative with antihuman Tamm-Horsfall glycoprotein. There were no significant differences in the median overall survival between the crystalline LCCN group and the ordinary LCCN group (6.0 months vs. 35.0 months, p = 0.173). However, crystalline LCCN patients had higher early mortality than ordinary LCCN patients (50.0% vs 11.1%, p = 0.03). CONCLUSION Crystalline LCCN patients had higher early mortality than ordinary LCCN patients. Thus, for patients with LCCN, crystalline appearance should be screened carefully.
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Affiliation(s)
- Zi-Shan Lin
- Renal Division, Department of Medicine, Peking University First Hospital, PR China; Institute of Nephrology, Peking University, PR China; Renal Pathology Center, Institute of Nephrology, Peking University, PR China; Key Laboratory of Renal Disease, Ministry of Health of China, PR China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, PR China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, PR China
| | - Xu Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, PR China; Institute of Nephrology, Peking University, PR China; Renal Pathology Center, Institute of Nephrology, Peking University, PR China; Key Laboratory of Renal Disease, Ministry of Health of China, PR China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, PR China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, PR China; Laboratory of Electron Microscopy, Pathological Centre, Peking University First Hospital, Beijing 100034, PR China
| | - Xiao-Juan Yu
- Renal Division, Department of Medicine, Peking University First Hospital, PR China; Institute of Nephrology, Peking University, PR China; Renal Pathology Center, Institute of Nephrology, Peking University, PR China; Key Laboratory of Renal Disease, Ministry of Health of China, PR China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, PR China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, PR China
| | - Shuang Wang
- Renal Division, Department of Medicine, Peking University First Hospital, PR China; Institute of Nephrology, Peking University, PR China; Renal Pathology Center, Institute of Nephrology, Peking University, PR China; Key Laboratory of Renal Disease, Ministry of Health of China, PR China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, PR China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, PR China; Laboratory of Electron Microscopy, Pathological Centre, Peking University First Hospital, Beijing 100034, PR China
| | - Su-Xia Wang
- Renal Division, Department of Medicine, Peking University First Hospital, PR China; Institute of Nephrology, Peking University, PR China; Renal Pathology Center, Institute of Nephrology, Peking University, PR China; Key Laboratory of Renal Disease, Ministry of Health of China, PR China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, PR China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, PR China; Laboratory of Electron Microscopy, Pathological Centre, Peking University First Hospital, Beijing 100034, PR China
| | - Yu-Jun Dong
- Department of Hematology, Peking University First Hospital, Beijing 100034, PR China
| | - Fu-De Zhou
- Renal Division, Department of Medicine, Peking University First Hospital, PR China; Institute of Nephrology, Peking University, PR China; Renal Pathology Center, Institute of Nephrology, Peking University, PR China; Key Laboratory of Renal Disease, Ministry of Health of China, PR China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, PR China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, PR China.
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, PR China; Institute of Nephrology, Peking University, PR China; Renal Pathology Center, Institute of Nephrology, Peking University, PR China; Key Laboratory of Renal Disease, Ministry of Health of China, PR China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, PR China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, PR China; Peking-Tsinghua Center for Life Sciences, Beijing 100034, PR China
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Garcia de Veas Silva JL, Gonzalez Cejudo MT, Garcia Perojil Jimenez A, Garcia Lopez Velez MDS, Garcia Rios Tamayo R, Garcia Bermudo Guitarte C, Garcia De Haro Muñoz T. HLC Pair Suppression as a Risk Factor for Bacterial Bloodstream Infections and Early Mortality in Newly Diagnosed Intact Immunoglobulin Multiple Myeloma Patients. Front Oncol 2021; 11:599532. [PMID: 33767978 PMCID: PMC7985068 DOI: 10.3389/fonc.2021.599532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
Despite the outstanding progresses in Multiple Myeloma treatment options in the last decades, it remains an incurable disease nowadays. Infectious events are a complication due to an impaired immune system associated with MM, sometimes a life-threatening one, particularly on the first months after the diagnosis. Both the underlying disease and treatment can contribute to the infection risk, so a biomarker that assess this risk could be highly relevant for a more tailored management of the patient. The measurement of the heavy+light chain (HLC) pairs of immunoglobulins in serum allows the quantification of both the monoclonal component and the non-monoclonal immunoglobulin of the same isotype. This approach has demonstrated high sensitivity for the detection of the clonality and prognostic value for MM. HLC pair suppression itself has prognostic power and it has been proposed to be a reflection of the immune system' attempt to control the tumor. In this study we evaluated the impact of the HLC pair suppression on the rate of bloodstream infections (BSI) and early death in 115 newly diagnosed MM patients. Twenty-one percent of the patients suffered a BSI in the first 6 months after diagnosis, of which 58% died within this period, accounting to 67% of the early deaths in global and highlighting the major impact of infections on MM patients in a "real world" setting. Severe HLC pair suppression identified patients with a higher risk of early BSI (HR: 6,97, p=0,009), and extreme HLC pair suppression together with BSI event and age >65 were independent risk factors for early death (p<0,001). Based on these factors, a stratification model was generated to allow identify patients at a higher risk of early death and poorer OS, with an apparently better performance than the ISS on the early death context. In conclusion, HLC pair suppression associates with both a higher risk of life-threatening early infection and early death in newly diagnosed MM patients. Patients older than 65 with extreme HLC pair suppression and BSI are at a high risk of early death, and thus patients presenting with these criteria have a very adverse prognosis.
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Cherniawsky HM, AlAhwal H, Mourad YA, Forrest D, Gerrie A, Kuchenbauer F, Nantel SH, Narayanan S, Nevill T, Power M, Sanford D, Toze C, White J, Escano L, Sutherland H, Song K. Mortality from Multiple Myeloma Within One Year Following Autologous Stem Cell Transplantation: Defining an Ultra-high Risk Population. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:476-482. [PMID: 33814336 DOI: 10.1016/j.clml.2021.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/21/2021] [Accepted: 02/27/2021] [Indexed: 11/30/2022]
Abstract
Despite improvements in therapy, approximately 5% of patients who undergo autologous stem cell transplantation (ASCT) experience early mortality (EM), death within 1 year of transplant (EM post-ASCT). Such patients tend to have few comorbidities suggesting their EM is owing to aggressive underlying disease. We sought to characterize this ultra-high risk population through a retrospective review of patients with newly diagnosed multiple myeloma (MM) treated with first-line ASCT. Patients who died within 1 year of ASCT were matched for age, sex, and year of transplant in a 1:2 fashion with a control group. Of 962 transplants performed between January 1, 2007, and May 1, 2019, 41 patients (4.3%) died within 1 year of ASCT from MM-related causes. In a multivariate analysis, anemia, hypercalcemia, high-risk cytogenetics, and elevated lactate dehydrogenase were associated with EM post-ASCT. Forty patients (97.6%) received at least 1 novel agent. Most patients with EM post-ASCT received second-line chemotherapy (80.5%), although survival from initiation of second-line chemotherapy was only 2.1 months. The primary reason for not receiving second-line therapy was rapid relapse. Clinical parameters reflecting disease burden, as well as high-risk cytogenetics, are associated with EM post-ASCT. These patients have a dismal overall survival despite significant advances in treatment of patients with relapsed or refractory myeloma. Further study of these ultra-high risk patients is required to improve disease management and may give further insights into the biology of relapse and resistance in myeloma.
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Affiliation(s)
| | - Hatem AlAhwal
- Department of Hematology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yasser Abou Mourad
- Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, Canada
| | - Donna Forrest
- Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, Canada
| | - Alina Gerrie
- Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, Canada
| | - Florian Kuchenbauer
- Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, Canada; Terry Fox Laboratory, BC Cancer Research Centre, Vancouver, Canada
| | - Stephen H Nantel
- Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, Canada
| | - Sujaatha Narayanan
- Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, Canada
| | - Thomas Nevill
- Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, Canada
| | - Maryse Power
- Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, Canada
| | - David Sanford
- Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, Canada
| | - Cynthia Toze
- Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, Canada
| | - Jennifer White
- Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, Canada
| | - Leo Escano
- Terry Fox Laboratory, BC Cancer Research Centre, Vancouver, Canada
| | - Heather Sutherland
- Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, Canada
| | - Kevin Song
- Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, Canada.
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18
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Kumar V, Ailawadhi M, Dutta N, Abdulazeez M, Aggarwal CS, Quintero G, Baksh M, Roy V, Sher T, Alegria V, Paulus A, Chanan-Khan A, Ailawadhi S. Trends in Early Mortality From Multiple Myeloma: A Population-Based Analysis. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2021; 21:e449-e455. [PMID: 33485835 DOI: 10.1016/j.clml.2020.12.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/21/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Despite significant improvements in multiple myeloma (MM) treatment modalities, patient mortality early in the course of disease has been identified as a persistent phenomenon with variable reported rates and causes. Trends in early mortality over time have not been clearly defined. PATIENTS AND METHODS The Surveillance Epidemiology and End Results (SEER) database was used to identify adult patients with MM between 1975 and 2015. Association of available sociodemographic factors with all-cause and MM-specific early mortality (death within 6 months after the diagnosis of MM) was conducted by multivariate analysis. Trends in early mortality were studied by joinpoint regression analysis. RESULTS Of the 90,975 MM cases included in this analysis, early mortality was noted in 21%. Median age was 68 years overall, and 75 years for the early mortality cohort (P < .01). The most common causes of death for early mortality were MM itself, followed by cardiovascular, infections, and renal failure. Male gender, "other" race/ethnicity group, advancing age, and West, Midwest or South regions (reference Northeast) were associated with increased risk of both all-cause and MM-specific early mortality. Joinpoint regression analysis of trends data resulted in 1 joinpoint for all-cause 6-month mortality (2006-2015), while 2 joinpoints were noticed for myeloma-specific 6-month mortality (1975-1987 and 2003-2015). CONCLUSION Early mortality remains a significant unmet need for MM patient care, despite improving trends in recent years. Understanding the factors associated with early mortality can help develop individualized plans of patient care and mitigate circumstances that may contribute to early mortality among MM patients.
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Affiliation(s)
- Vivek Kumar
- Department of Medicine, Brigham and Women's Hospital/Dana Farber Cancer Institute Boston, Boston, MA
| | | | - Navnita Dutta
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL
| | - Mays Abdulazeez
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL
| | | | - Gerson Quintero
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL
| | - Mizba Baksh
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL
| | - Vivek Roy
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL
| | - Taimur Sher
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL
| | | | - Aneel Paulus
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL
| | - Asher Chanan-Khan
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL; Hematology-Oncology, St Vincent's Medical Center-Riverside, Jacksonville, FL
| | - Sikander Ailawadhi
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL; Department of Cancer Biology, Mayo Clinic, Jacksonville, FL.
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19
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Covut F, Driscoll JJ, Cooper B, Gallogly M, De Lima M, Malek E. Racial and age-related disparities in early mortality affect the outcomes of multiple myeloma patients. Leukemia 2020; 35:250-254. [PMID: 32448865 DOI: 10.1038/s41375-020-0812-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/11/2020] [Accepted: 03/18/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Fahrettin Covut
- Adult Hematologic Malignancies & Stem Cell Transplant Section, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - James Joseph Driscoll
- Adult Hematologic Malignancies & Stem Cell Transplant Section, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Brenda Cooper
- Adult Hematologic Malignancies & Stem Cell Transplant Section, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Molly Gallogly
- Adult Hematologic Malignancies & Stem Cell Transplant Section, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Marcos De Lima
- Adult Hematologic Malignancies & Stem Cell Transplant Section, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Ehsan Malek
- Adult Hematologic Malignancies & Stem Cell Transplant Section, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. .,Case Western Reserve University, Cleveland, OH, USA.
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20
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Ailawadhi S, Jagannath S, Narang M, Rifkin RM, Terebelo HR, Toomey K, Durie BGM, Hardin JW, Gasparetto CJ, Wagner L, Omel JL, Kumar V, Yue L, Kitali A, Agarwal A, Abonour R. Connect MM Registry as a national reference for United States multiple myeloma patients. Cancer Med 2019; 9:35-42. [PMID: 31701679 PMCID: PMC6943143 DOI: 10.1002/cam4.2656] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 02/06/2023] Open
Abstract
Background The Surveillance, Epidemiology, and End Results (SEER) database and National Cancer Database (NCDB) show improved overall survival (OS) in patients with multiple myeloma (MM) over the last 15 years. This analysis evaluated the validity of the largely community‐based Connect MM Registry as a national reference for MM. Methods Baseline disease characteristics and survival in US newly diagnosed MM patients were examined using the Connect MM Registry as well as SEER and NCDB databases. Baseline characteristics predictive of longer survival in Connect MM were also identified. Results As of February 2017, 3011 patients were enrolled in the Connect MM Registry; 2912 were treated. Median age at time of MM diagnosis and age range were numerically similar from 2010 to 2015 across all 3 registries; SEER had a higher representation of nonwhite racial groups than that in the other 2 registries. OS rates suggest proportionate improvement with year of diagnosis among the 3 registries. A Cox proportional hazards model suggests that younger age (<65 years) is associated with longer survival (vs ≥75; HR, 0.39; 95% confidence interval, 0.34‐0.46) in the Connect MM Registry. However, sex (HR, 0.91; P = .15) and race (black vs white; HR, 0.88; P = .21) were not associated with longer OS. Conclusions Data from the Connect MM Registry appear to be largely representative of national trends, comprehensive, and reliable representations of the national MM population. Baseline characteristics were comparable, and survival similarly improved over time among the 3 registries. ClinicalTrials.gov, identifier NCT01081028.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Lynne Wagner
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - James L Omel
- Myeloma Research Advocate/Advisor, Grand Island, NE, USA
| | - Vivek Kumar
- Brigham and Women's Hospital, Boston, MA, USA
| | - Lihua Yue
- Celgene Corporation, Summit, NJ, USA
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21
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Terebelo HR, Abonour R, Gasparetto CJ, Toomey K, Durie BGM, Hardin JW, Jagannath S, Wagner L, Narang M, Flick ED, Srinivasan S, Yue L, Kitali A, Agarwal A, Rifkin RM. Development of a prognostic model for overall survival in multiple myeloma using the Connect ® MM Patient Registry. Br J Haematol 2019; 187:602-614. [PMID: 31382320 PMCID: PMC6899784 DOI: 10.1111/bjh.16139] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/10/2019] [Indexed: 02/02/2023]
Abstract
Median overall survival (OS) has improved for patients with newly diagnosed multiple myeloma (NDMM), but prognosis varies depending on baseline patient characteristics. Current models use data from selected clinical trial populations, which prevent application to patients in an unselected community setting that reflects routine clinical practice. Using data from the Connect® MM Registry, a large, US, multicentre, prospective observational cohort study (Cohort 1: 2009-2011; Cohort 2: 2012-2016) of 3011 patients with NDMM, we identified prognostic variables for OS via the multivariable analysis of baseline patient characteristics in Cohort 1 (n = 1493) and developed a tool to examine individual outcomes. Factors associated with OS (n = 1450 treated patients; P < 0·05) were age, del(17p), triplet therapy use, EQ-5D mobility, International Staging System stage, solitary plasmacytoma, history of diabetes, platelet count, Eastern Cooperative Oncology Group performance status and serum creatinine, which were used to create survival matrices for 3- and 5-year OS. The model was internally and externally validated using Connect MM Cohort 2 (Harrell's concordance index, 0·698), MM-015 (0·649), and the phase 3 FIRST (0·647) clinical trials. This novel prognostic tool may help inform outcomes for NDMM in the era of triplet therapy use with novel agents.
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Affiliation(s)
| | | | | | | | | | | | | | - Lynne Wagner
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | | - Lihua Yue
- Celgene Corporation, Summit, NJ, USA
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22
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Mohty M, Cavo M, Fink L, Gonzalez-McQuire S, Leleu H, Mateos MV, Raab MS, Schoen P, Yong K. Understanding mortality in multiple myeloma: Findings of a European retrospective chart review. Eur J Haematol 2019; 103:107-115. [PMID: 31112311 PMCID: PMC6851592 DOI: 10.1111/ejh.13264] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 12/13/2022]
Abstract
Objectives This study aimed to provide real‐world data on the characteristics and treatment of patients with multiple myeloma (MM) at the time of death. Methods The study was a retrospective patient chart review across France, Germany, Italy, Spain and the UK during 2016, and included patients who had died in the 3 months before the index date. Results Data from 786 patients were reviewed. At the time of death, 37% of patients were receiving active treatment, 12% were in a treatment‐free interval and 51% were receiving only supportive care. Death before and during active first‐line treatment was not uncommon (6% and 24% of patients, respectively) but these deaths were often not solely due to disease progression; factors such as renal failure and infection frequently played a role (in 30% and 20% of patients at first‐line, respectively). Most deaths at later lines were due to progressive disease. Cox model results suggested that early deaths were associated with advanced disease stage, high‐risk cytogenetics and poor response and relapse profiles. Conclusions These real‐world data could be used to help develop strategies for improving survival in patients with MM and to support management tailored to the stage of disease.
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Affiliation(s)
- Mohamad Mohty
- Department of Haematology, Hôpital Saint-Antoine, Universite Pierre & Marie Curie, INSERM UMRs 938, Paris, France
| | - Michele Cavo
- Seràgnoli Institute of Haematology and Medical Oncology, Bologna University School of Medicine, Bologna, Italy
| | | | | | | | - Maria-Victoria Mateos
- Haematology Department, University Hospital of Salamanca/Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Marc S Raab
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Kwee Yong
- Department of Haematology, University College London, London, UK
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23
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Mellors PW, Binder M, Buadi FK, Lacy MQ, Gertz MA, Dispenzieri A, Hayman SR, Kapoor P, Gonsalves WI, Hwa YL, Fonder A, Hobbs M, Kourelis T, Warsame R, Zeldenrust SR, Lust JA, Leung N, Go RS, Kyle RA, Rajkumar SV, Kumar SK. Development of thrombocytopenia during first-line treatment and survival outcomes in newly diagnosed multiple myeloma. Leuk Lymphoma 2019; 60:2960-2967. [DOI: 10.1080/10428194.2019.1613536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | | | - Yi L. Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - John A. Lust
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Ronald S. Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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24
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Impact of post-ASCT maintenance therapy on outcomes in patients with newly diagnosed multiple myeloma in Connect MM. Blood Adv 2019; 2:1608-1615. [PMID: 29986853 DOI: 10.1182/bloodadvances.2018017186] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/30/2018] [Indexed: 01/21/2023] Open
Abstract
Autologous stem cell transplantation (ASCT) followed by lenalidomide maintenance therapy is the standard of care for transplant-eligible patients with newly diagnosed multiple myeloma (NDMM). Clinical trials show progression-free survival (PFS) benefits, with some studies (Cancer and Leukemia Group [CALGB] trial and meta-analysis) also showing overall survival (OS) benefits, but applicability to real-world clinical settings is unclear. Using data from Connect MM, the largest US-based observational registry of NDMM patients, we analyzed effects of maintenance therapy on long-term outcomes in 1450 treated patients enrolled from 2009 to 2011. Patients who received induction therapy and ASCT (n = 432) were analyzed from 100 days post-ASCT (data cut 7 January 2016): 267 received maintenance (80% lenalidomide-based [of whom 88% received lenalidomide monotherapy]); 165 did not. Lenalidomide maintenance improved median PFS and 3-year PFS rate vs no maintenance (50.3 vs 30.8 months [hazard ratio (HR), 0.62; 95% confidence interval (CI), 0.46-0.82; P < .001] and 56% vs 42%, respectively). Improvements in median OS and 3-year OS rate were associated with lenalidomide maintenance vs no maintenance (not reached in either group [HR, 0.54; 95% CI, 0.36-0.83; P = .005] and 85% vs 70%, respectively). Five hematologic serious adverse events were reported with lenalidomide maintenance (pancytopenia [n = 2], febrile neutropenia, anemia, and thrombocytopenia [n = 1 each]) and 1 with no maintenance (thrombocytopenia). Second primary malignancies occurred at rates of 1.38 and 2.19 events per patient-year in lenalidomide maintenance and no maintenance groups, respectively. Survival benefits associated with lenalidomide maintenance previously demonstrated in clinical trials were observed in this community-based Connect MM Registry.
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25
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Radocha J, Hájek R, Brožová L, Pour L, Špička I, Minařík J, Gregora E, Jungová A, Jelínek T, Heindorfer A, Sýkora M, Maisnar V. Simplified novel prognostic score for real-life older adults with multiple myeloma-registry-based analysis. Ann Hematol 2018; 98:951-962. [PMID: 30539278 DOI: 10.1007/s00277-018-3568-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 11/26/2018] [Indexed: 11/24/2022]
Abstract
The main goal was to find a simple prognostic to evaluate overall survival of patients older than 65 years of age with myeloma. Retrospective registry-based analysis from the Registry of Monoclonal Gammopathies was conducted. Patients over 65 years with symptomatic myeloma were included. The four major parameters with impact on survival were identified: male gender, age > 75, creatinine > 152 μmol/L, and ECOG performance status 2-4. The patients were scored as good (0 points), intermediate good (1 point), intermediate poor (2 points), poor (3-4 points). Patients (1410 MM) were included. Median OS (months) was 65.7 (95% CI 49.8-81.7) for good, 51.0 (44.1-57.8) for intermediate good, 32.2 (26.2-38.2) for intermediate poor, and 18.9 (15.1-22.7) for poor. The differences in OS were statistically significant (p < 0.0001). Good score was used as reference for hazard ratios, which for each other score were 1.43 (1.09-1.84) for intermediate good, 2.58 (2.00-3.33) for intermediate poor, and 3.88 (2.94-5.10) for poor. Time to progression showed medians (months) 20.5 (17.4-62.4) for good, 19.3 (17.0-21.7) for intermediate good, 19.6 (16.2-23.0) for intermediate poor, and 13.0 (10.8-15.2) for poor. The suggested scoring system provides readily available information about the prognosis of MM patients above 65 years.
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Affiliation(s)
- J Radocha
- 4th Department of Internal Medicine - Hematology, Faculty Hospital, Charles University, Hradec Králové, Czech Republic. .,Czech Myeloma Group, Brno, Czech Republic.
| | - R Hájek
- Czech Myeloma Group, Brno, Czech Republic.,Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine University of Ostrava, Ostrava, Czech Republic
| | - L Brožová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - L Pour
- Czech Myeloma Group, Brno, Czech Republic.,Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine Masaryk Universtiy, University Hospital Brno, Brno, Czech Republic
| | - I Špička
- Czech Myeloma Group, Brno, Czech Republic.,1st Medical Department - Clinical Department of Haematology of the First Faculty of Medicine and General Teaching Hospital, Charles University, Prague, Czech Republic
| | - J Minařík
- Czech Myeloma Group, Brno, Czech Republic.,Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, Olomouc, Czech Republic
| | - E Gregora
- Czech Myeloma Group, Brno, Czech Republic.,Department of Internal Medicine and Hematology, 3rd Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - A Jungová
- Czech Myeloma Group, Brno, Czech Republic.,Hematology and Oncology Department, Charles University Hospital Pilsen, Prague, Czech Republic
| | - T Jelínek
- Czech Myeloma Group, Brno, Czech Republic.,Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine University of Ostrava, Ostrava, Czech Republic
| | - A Heindorfer
- Czech Myeloma Group, Brno, Czech Republic.,Department of Clinical Hematology, Hospital Liberec, Liberec, Czech Republic
| | - M Sýkora
- Czech Myeloma Group, Brno, Czech Republic.,Department of Clinical Hematology, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - V Maisnar
- 4th Department of Internal Medicine - Hematology, Faculty Hospital, Charles University, Hradec Králové, Czech Republic.,Czech Myeloma Group, Brno, Czech Republic
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26
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Radocha J, Maisnar V, Pour L, Špička I, Minařík J, Szeligová L, Pavlíček P, Jungová A, Krejčí M, Pika T, Straub J, Brožová L, Stejskal L, Heindorfer A, Jindra P, Kessler P, Mikula P, Sýkora M, Wróbel M, Jarkovský J, Hájek R. Validation of multiple myeloma risk stratification indices in routine clinical practice: Analysis of data from the Czech Myeloma Group Registry of Monoclonal Gammopathies. Cancer Med 2018; 7:4132-4145. [PMID: 29931775 PMCID: PMC6089168 DOI: 10.1002/cam4.1620] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/15/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022] Open
Abstract
This study used data from the Czech Myeloma Group Registry of Monoclonal Gammopathies to validate the International Myeloma Working Group (IMWG) and revised International Staging System (R-ISS) indices for risk stratification in patients with multiple myeloma (MM) in clinical practice. Patients were included if they had symptomatic MM, complete data allowing R-ISS and IMWG staging (including cytogenetic information regarding t(4;14), t(14;16), and del(17p)), and key parameters for treatment evaluation. Median overall survival (OS) in included patients (n = 550) was 47.7 (95% CI: 39.5-55.9) and 46.2 (95% CI: 38.9-53.5) months from diagnosis and initiation of first-line therapy, respectively. Patients categorized as higher vs lower risk had reduced survival; median OS from diagnosis was 35.4 (95% CI: 30.5-40.3) vs 58.3 (95% CI: 53.8-62.9) months in high-risk vs other patients (IMWG; P = .001) and 34.1 (95% CI: 30.2-38.0) vs 47.2 (95% CI: 43.4-51.0) months in Stage III vs Stage II patients (R-ISS; P < .001). In conclusion, IMWG and R-ISS risk stratification indices are applicable to patients with MM in a real-world setting.
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Affiliation(s)
- Jakub Radocha
- 4th Department of Medicine - Haematology, Faculty of Medicine, Charles University Hospital, Hradec Králové, Czech Republic
| | - Vladimír Maisnar
- 4th Department of Medicine - Haematology, Faculty of Medicine, Charles University Hospital, Hradec Králové, Czech Republic
| | - Luděk Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Ivan Špička
- 1st Medical Department - Clinical Department of Haematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Jiři Minařík
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University, Olomouc, Czech Republic
| | - Lenka Szeligová
- Department of Haemato-Oncology, Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | - Petr Pavlíček
- Department of Internal Medicine and Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Alexandra Jungová
- Hematology and Oncology Department, Charles University Hospital, Pilsen, Czech Republic
| | - Marta Krejčí
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Tomáš Pika
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University, Olomouc, Czech Republic
| | - Jan Straub
- 1st Medical Department - Clinical Department of Haematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Lucie Brožová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lukáš Stejskal
- Department of Hematology, Hospital Opava, Opava, Czech Republic
| | | | - Pavel Jindra
- Hematology and Oncology Department, Charles University Hospital, Pilsen, Czech Republic
| | - Petr Kessler
- Department of Hematology and Transfusion Medicine, Hospital Pelhrimov, Pelhrimov, Czech Republic
| | - Peter Mikula
- Department of Clinical Haematology, Hospital in Havirov, Havirov, Czech Republic
| | - Michal Sýkora
- Department of Clinical Hematology, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Marek Wróbel
- Department of Hematology, Hospital Novy Jicin, Novy Jicin, Czech Republic
| | - Jiří Jarkovský
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Roman Hájek
- Department of Haemato-Oncology, Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
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Jagannath S, Abonour R, Durie BGM, Gasparetto C, Hardin JW, Narang M, Terebelo HR, Toomey K, Wagner L, Srinivasan S, Kitali A, Yue L, Flick ED, Agarwal A, Rifkin RM. Heterogeneity of Second-Line Treatment for Patients With Multiple Myeloma in the Connect MM Registry (2010-2016). CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:480-485.e3. [PMID: 29844008 DOI: 10.1016/j.clml.2018.04.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/20/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The treatment landscape for multiple myeloma (MM) has undergone recent changes with the regulatory approval of several new therapies indicated for second- and later-line disease. Using data from Connect MM, the largest multisite, primarily community-based, prospective, observational registry of MM patients in the United States, selection of second-line treatments was evaluated during a 5-year period from 2010 to 2016. PATIENTS AND METHODS Eligible patients were aged ≥ 18 years, had newly diagnosed MM ≤ 2 months before study entry, and were followed for up to 8 years. Patients who received ≥ 2 lines of therapy were analyzed. "Tepee" plots of stacked area graphs differentiated treatments by color to allow visualization of second-line treatment trends in MM patients. RESULTS As of February 2017, 855 of 2897 treated patients had progressed to second-line treatment. Treatment selection was heterogeneous; shifting patterns of treatment choices coincided with the approval status of newer agents. The most common treatment regimens in the early part of the decade were lenalidomide and/or bortezomib, with or without dexamethasone, with increasing use of newer agents (carfilzomib, pomalidomide, daratumumab, and elotuzumab) and triplet combinations over time. The influence of the baseline patient characteristics of age, history of diabetes, peripheral neuropathy, and renal function on treatment choice was also examined. CONCLUSION These findings indicate that community physicians are current in their MM management practices, with uptake of new drugs and acquaintance with results of randomized clinical trials using combinations almost concurrent with their regulatory approval and publication.
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Affiliation(s)
| | - Rafat Abonour
- Indiana University Simon Cancer Center, Indianapolis, IN
| | | | | | | | - Mohit Narang
- US Oncology Research, Maryland Oncology Hematology, Columbia, MD
| | | | | | - Lynne Wagner
- Wake Forest University School of Medicine, Winston-Salem, NC
| | | | | | | | | | | | - Robert M Rifkin
- US Oncology Research, Rocky Mountain Cancer Centers, Denver, CO
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Terebelo H, Srinivasan S, Narang M, Abonour R, Gasparetto C, Toomey K, Hardin JW, Larkins G, Kitali A, Rifkin RM, Shah JJ. Recognition of early mortality in multiple myeloma by a prediction matrix. Am J Hematol 2017; 92:915-923. [PMID: 28543165 PMCID: PMC5601204 DOI: 10.1002/ajh.24796] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/05/2017] [Accepted: 05/21/2017] [Indexed: 12/20/2022]
Abstract
Early mortality (EM; death ≤ 6 months from diagnosis) has been reported in several newly diagnosed multiple myeloma (NDMM) trials. Before the era of novel agents, the incidence was 10%‐14%. Causes of death included infections/pneumonia, renal failure, refractory disease, and cardiac events. Staging systems, such as the revised International Staging System (r‐ISS), and prognostic factors including cytogenetics, lactate dehydrogenase levels, and myeloma‐specific factors, are useful to assess overall prognosis; however, they cannot predict EM. We evaluated patients treated with novel agents in the Connect MM® Registry and identified risk factors of the EM cohort. Eligible patients were enrolled in the registry within 60 days of diagnosis. Univariate and multivariate analyses were conducted to evaluate associations between baseline characteristics and EM. Prediction matrices for EM were constructed from a logistic model. Between September 2009 and December 2011, 1493 patients were enrolled in the registry and had adequate follow‐up. Of these patients, 102 (6.8%) had EM and 1391 (93.2%) survived for > 180 days. Baseline factors significantly associated with increased EM risk included age > 75 years, higher Eastern Cooperative Oncology Group performance status, lower EQ‐5D mobility score, higher ISS stage, lower platelet count, and prior hypertension. Renal insufficiency trended toward increased EM risk. These risk factors were incorporated into a prediction matrix for EM. The EM prediction matrix uses differential weighting of risk factors to calculate EM risk in patients with NDMM. Identifying patients at risk for EM may provide new opportunities to implement patient‐specific treatment strategies to improve outcomes.
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Affiliation(s)
| | | | | | - Rafat Abonour
- Indiana University Simon Cancer Center; Indianapolis Indiana
| | - Cristina Gasparetto
- Division of Cellular Therapy; Duke University Medical Center; Durham North Carolina
| | | | | | | | | | - Robert M. Rifkin
- US Oncology Research, Rocky Mountain Cancer Centers; Denver Colorado
| | - Jatin J. Shah
- The University of Texas MD Anderson Cancer Center; Houston Texas
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