The risk of early death is disproportionately high in older patients with multiple myeloma (MM), researchers reported in Cancer.
The researchers found that MM patients aged 70 years or older have a nearly 3-fold higher rate of early death than younger MM patients.
The researchers reviewed electronic health record data from 7512 patients diagnosed with MM between 2011 and 2021. All patients had documented first-line therapy initiated within 90 days of diagnosis.
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Patients were divided into an older cohort (70 years and older) and a younger cohort (younger than 70 years of age). At baseline, the older cohort was more likely than the younger cohort to have comorbidities, worse ECOG performance status, and Revised International Staging System (R-ISS) stage III disease. There was no difference between the groups as far as high-risk cytogenetics or elevated lactate dehydrogenase levels.
Early death, defined as death within 6 months of diagnosis, occurred in 8.3% of patients overall. A minority of these patients (8.7%) had documented disease progression.
The rate of early death was 12% in the older cohort and 4.5% in the younger cohort. Most early deaths (73%) occurred in the older cohort.
In a multivariate analysis, factors associated with early death included:
- Age 70 years or older (odds ratio [OR], 2.23; 95% CI, 1.82-2.74; P <.001)
- ECOG performance status of 2 or higher (OR, 3.25; 95% CI, 2.35-4.50; P <.001)
- R‐ISS stage III disease (OR, 3.24; 95% CI, CI, 2.16-4.84; P <.001)
- R‐ISS stage II disease (OR, 2.63; 95% CI, 1.74-3.97; P <.001)
- Receipt of proteasome inhibitor‐based doublet therapy (vs triplet therapy with a proteasome inhibitor and an immunomodulatory drug; OR, 2.23; 95% CI, 1.74-2.89; P <.001)
- Light‐chain disease (OR, 1.64; 95% CI, 1.30-2.07; P <.001)
- Presence of renal dysfunction (OR, 1.48; 95% CI, 1.17-1.88; P <.001).
In the older cohort, the strongest predictors of early death were ECOG performance status of 2 or higher (OR, 3.18; 95% CI, 2.13-4.73; P <.001) and R-ISS stage III disease (OR, 3.96; 95% CI, 2.33-6.72; P <.001).
“The disproportionate impact of early mortality among those aged ≥70 years highlights a need for tailored approaches to the care of older adults with newly diagnosed MM,” the researchers concluded.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
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. Published online March 29, 2023. doi:10.1002/cncr.34760
