A new study suggests that multiple myeloma (MM) patients aged 75 years and older present with more advanced disease and have worse survival outcomes in the real world than in randomized controlled trials (RCTs). This study was published in Haematologica.
Data for the study were sourced from 2 nationwide population-based registries. The patients were diagnosed with MM in Denmark (n=4691) from January 1, 2005, through February 18, 2020, or in Sweden (n=7334) from January 1, 2008, through December 31, 2019.
The proportion of patients who were 75 years and older was 36.0% in the Danish cohort and 40.3% in the Swedish cohort. When compared with patients younger than 75 years of age, the older patients were more likely to be women and to have more advanced disease at diagnosis.
For the older cohort, the use of first-line treatments incorporating immunomodulatory drugs and proteasome inhibitors increased over time. In Denmark, the proportion of patients using these drugs in first-line treatment increased from 18.1% in 2005 to 89.1% in 2018. In Sweden, the proportion of patients receiving these drugs upfront increased from 29.9% in 2008 to 95.5% in 2018.
The researchers compared trends in these real-world older patients with data from older patients enrolled in 4 RCTs — VISTA (ClinicalTrials.gov Identifier: NCT00111319), FIRST (ClinicalTrials.gov Identifier: NCT00689936), ALCYONE (ClinicalTrials.gov Identifier: NCT02195479), and MAIA (ClinicalTrials.gov Identifier: NCT02252172).
Patients aged 75 and older were generally more likely to have International Staging System stage III disease in the real-world cohorts than in the RCTs. The proportion of patients with stage III disease was 46% in the Denmark cohort, 47% in the cohort from Sweden, 34% and 35% in the 2 arms of the VISTA trial, 48% in the FIRST trial, 38% in ALCYONE, and 29% in the MAIA trial.
The real-world patients aged 75 and older also had inferior overall survival (OS) outcomes compared with the RCT participants who were 75 and older. However, OS improved over time among real-world patients.
In the cohort from Denmark, the median OS was 20 months in 2005-2007 and 30 months in 2017-2018. In the Swedish cohort, the median OS was 20 months in 2008-2009 and 34 months in 2018-2019.
The median OS was 43 months among patients aged 75 and older who received bortezomib, melphalan, and prednisolone in the VISTA trial. In the FIRST trial, older patients had a median OS of 48 months with continuous lenalidomide and dexamethasone, 46 months with lenalidomide and dexamethasone given for 18 months, and 38 months with combination melphalan, prednisolone, and thalidomide.
In the ALCYONE trial, the median OS was not reached in either treatment arm at a median follow-up of 40.1 months. In MAIA, the median OS was not reached in either arm at a median follow-up of 60 months.
Moore KLF, Turesson I, Genell A, et al. Improved survival in myeloma patients – A nationwide registry study of 4647 patients ≥75 years treated in Denmark and Sweden. Haematologica. Published online October 27, 2022. doi:10.3324/haematol.2021.280424