Outcome and survival of myeloma patients diagnosed 2008–2015. Real-world data on 4904 patients from the Swedish Myeloma Registry

Abstract

Epidemiology and outcome of myeloma are mainly reported from large university centers and collaborative groups, and do not represent ‘real-world’ patients. The Swedish Myeloma Registry is a prospective population-based registry documenting characteristics, treatment and outcome in newly diagnosed myeloma, including asymptomatic and localized forms, with the purpose of improving disease management and outcome. This report presents information on patients diagnosed between 2008 and 2015, including data on first-line treatment in patients diagnosed up to 2014, with a follow up until December 2016. We present age-adjusted incidence, patients’ characteristics at baseline, treatment, response, and survival. Baseline data were available with a 97% coverage in 4904 patients (median age 71 years, males 70 years, females 73 years; 72% were 65 years or older), and at 1-year follow up in 3558 patients with symptomatic disease (92% of patients initially reported). The age-adjusted incidence was 6.8 myeloma cases per 100,000 inhabitants per year. Among initially symptomatic patients (n=3988), 77% had osteolytic lesions or compression fractures, 49% had anemia, 18% impaired kidney function, and 13% hypercalcemia. High-dose therapy with autologous stem cell transplantation was given to 77% of patients aged up to 66 years, and to 22% of patients aged 66–70 years. In the study period, 68% received bortezomib, thalidomide, and/or lenalidomide as part of the first-line treatment, rising from 31% in 2008 to 81% in 2014. In active myeloma, the median relative survival of patients aged 65 years or under was 7.7 years, and 3.4 years in patients aged 66 years and over. Patients diagnosed with myeloma in more recent years were associated with significantly higher rates of complete or very good partial remission (P<0.05), and with a significantly higher survival, with a Hazard Ratio (HR) of 0.84 (95%CI: 0.77–0.92; P<0.05). There was a small, but significant survival benefit in patients treated at university hospitals (HR 0.93; 95%CI: 0.87–0.99; P<0.05). We report here on a near complete ‘real-world’ population of myeloma patients during an 8-year period; a period in which newer drugs were implemented into standard practice. The overall incidence and median age were both higher than in most previous studies, indicating a more complete coverage of older patients. Myeloma survival in Sweden is comparable to other large registry studies, and responses and survival improved during the study period.

Impact of increased access to novel agents on the survival of multiple myeloma patients treated at a single New Zealand centre

“…Consistent with results from both international population studies and NZ cancer registry data, patients in the later cohort had a significantly increased OS. The 5‐year relative survival of the later cohort (49%) was similar to that reported in the most recent population data from Australia (49%), the United States (51%) and Sweden (51%) . The Swedish data are of particular relevance as they cover a similar time period and, in common with NZ, frontline use of bortezomib or thalidomide was standard of care with a high level of NA use …”

“…Population studies of MM have consistently reported increased OS in recent decades, with these increases being attributed to the increased use of NA . In the current study, the survival outcomes of patients diagnosed and treated before and after the introduction of bortezomib were compared.…”

“…During the past 20 years, advances in treatment have had a major impact on the survival of multiple myeloma (MM) patients . The introduction of high‐dose therapy followed by an autologous stem cell transplant (ASCT) significantly improved outcomes and remains the standard of care for younger patients .…”

“…During the past 20 years, advances in treatment have had a major impact on the survival of multiple myeloma (MM) patients. [1][2][3] The introduction of high-dose therapy followed by an autologous stem cell transplant (ASCT) significantly improved outcomes and remains the standard of care for younger patients. [4][5][6] A further rapid evolution in the treatment of both ASCT eligible and ineligible patients has since occurred with the introduction of novel agents (NA) such as the proteasome inhibitor bortezomib and the immunomodulatory drugs lenalidomide and thalidomide.…”

Rapidly changing myeloma epidemiology in the general population: Increased incidence, older patients, and longer survival

“…Because the average age of onset is 70–75 years, multiple myeloma is mainly a disease of the elderly and it has a steep increase in incidence with advancing age (2–3). The incidence of multiple myeloma is about 1.5 times higher in males than in females (4). Specifically, in the U.S., the 2011–2012 incidence of multiple myeloma (adjusted to the US standard population) was 7.8 per 100,000 person-years and 5.1 per 100,000 person-years for males and females, respectively (5).…”