Improved survival in myeloma patients: starting to close in on the gap between elderly patients and a matched normal population

Abstract

The outcome for multiple myeloma patients has improved since the introduction of bortezomib, thalidomide and lenalidomide. However, studies comparing new and conventional treatment include selected patient groups. We investigated consecutive patients (n = 1638) diagnosed in a defined period and compared survival with a gender-and age-matched cohort Swedish population (n = 9 340 682). Median overall survival for non-high-dose treated patients was 2Á8 years. The use of bortezomib, thalidomide or lenalidomide in first line therapy predicted a significantly longer overall survival (median 4Á9 years) compared to conventional treatment (2Á3 years). Among non-high-dose treated patients receiving at least 2 lines with bortezomib, thalidomide or lenalidomide, 69% and 63% have survived at 3 and 5 years as compared to 48% and 22% with conventional drugs and 88% and 79% in the matched cohort populations, respectively. The median overall survival in high-dose treated patients was 6Á9 years. Of these patients, 84% survived at 3 years and 70% at 5 years as compared to 98% and 95% in the matched cohort population. Overall survival in the best non-high-dose treated outcome group is closing the gap with the matched cohort. Upfront use of new drugs is clearly better than waiting until later lines of treatment.

Analysis of renal impairment in MM-003, a phase III study of pomalidomide + low - dose dexamethasone versus high - dose dexamethasone in refractory or relapsed and refractory multiple myeloma

“…28,29 In addition, although newer agents can improve outcomes, including renal function, for many patients with MM with renal impairment, 5,7 it remains a significant risk factor for early death in MM. 3,30 Thus, the efficacy of POM + LoDEX in renally impaired relapsed/refractory MM populations is of particular importance.…”

Autologous stem cell transplantation versus novel drugs or conventional chemotherapy for patients with relapsed multiple myeloma after previous ASCT

“…In spite of the appearance of numerous novel drugs-proteasome inhibitors (PI) and immunomodulatory drugs (IMiDs) 1 -almost all patients below 60-65 years of age are treated upfront with autologous stem cell transplantation (ASCT). Still almost all patients progress because of residual disease.…”

“…Previous retrospective studies have indicated that a second ASCT is beneficial at relapse, at least if relapse occurs later than 18 months from initial treatment. 11 However, the development of novel drugs, for example, PI and IMiDs 1,[12][13][14][15] have raised the question if a second ASCT could be replaced by these drugs in second line. [16][17][18] A recent prospective study has shown that HDT followed by ASCT is superior to a cyclophosphamide-based regimen but data are lacking for comparing the novel drugs to ASCT.…”

Trends in survival of multiple myeloma: A thirty-year population-based study in a single institution

“…Several groups have reported on progressive OS improvement in MM [13][14][15][16][17][18][19][20][21][22][23][24]. Table 6 summarizes the results of the most relevant studies about survival in MM.…”