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Impact of age, race and decade of treatment on overall survival in a critical population analysis of 40,000 multiple myeloma patients

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Abstract

With the availability of novel agents, the overall survival (OS) in patients diagnosed with multiple myeloma (MM) has improved over the last decade. Data on 40,294 MM patients in the years from 1973 to 2003 were obtained from the Surveillance, Epidemiology, and End Results Program (SEER) of the US National Cancer Institute. Statistical analyses evaluating gender, race, age, and year of diagnosis were performed using univariate and multivariate Cox regression models for the OS endpoint. The mean patient age at diagnosis was 68.3 years. Mean survival was 30 months (median = 19 months). Asian/Pacific Islander race was associated with an improved OS, HR 0.90 (CI 0.86–0.95, P < 0.001). American Indian/Alaska Native race was associated with a decreased OS, HR 1.18 (CI 1.01–1.38, P = 0.040). Multivariate analysis did not reveal statistically significant differences in OS between patients in the white and black race (P = 0.709). Younger age (age <65, and 65–75) was associated with improved OS when compared with patients >75 years of age (all P < 0.001). Recent treatment decades (1983–1992 and 1993–2003) were associated with improved OS on multivariate analysis with HR 0.88 (CI 0.88–0.89, P < 0.001) and HR 0.83 (CI 0.81–0.85, P < 0.001), respectively. As the largest population analysis to date, this study reveals a statistically significant improvement in OS for patients who were treated in more recent decades, even before the availability of novel agents. Patients who were <65 years of age and Asian/Pacific Islander race groups exhibited superior levels of OS, whereas American Indian/Alaska Native groups had decreased OS.

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Notes

  1. Personal written communication with the Center for International Blood and Marrow Transplant Research (CIBMTR) M, WI. The data presented here are preliminary and were obtained from the Statistical Center of CIBMTR. The analysis has not been reviewed or approved by the Advisory or Scientific Committees of the CIBMTR.

References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59:225–49.

    Article  PubMed  Google Scholar 

  2. Rades D, Bohlen G, Pluemer A, Veninga T, Hanssens P, Dunst J, et al. Stereotactic radiosurgery alone versus resection plus whole-brain radiotherapy for 1 or 2 brain metastases in recursive partitioning analysis class 1 and 2 patients. Cancer. 2007;109:2515–21.

    Article  PubMed  Google Scholar 

  3. Blokhin N, Larionov L, Perevodchikova N, Chebotareva L, Merkulova N. Clinical experiences with sarcolysin in neoplastic diseases. Ann N Y Acad Sci. 1958;68:1128–32.

    Article  PubMed  CAS  Google Scholar 

  4. Salmon SE, Shadduck RK, Schilling A. Intermittent high-dose prednisone (NSC-10023) therapy for multiple myeloma. Cancer Chemother Rep. 1967;51:179–87.

    PubMed  CAS  Google Scholar 

  5. McIntyre OR, Pajak TF, Kyle RA, Cornwell GG 3rd, Leone L. Response rate and survival in myeloma patients receiving prednisone alone. Med Pediatr Oncol. 1985;13:239–43.

    Article  PubMed  CAS  Google Scholar 

  6. Attal M, Harousseau JL, Stoppa AM, Sotto JJ, Fuzibet JG, Rossi JF, et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Francais du Myelome. N Engl J Med. 1996;335:91–7.

    Article  PubMed  CAS  Google Scholar 

  7. Labardini-Mendez J, Alexanian R, Barlogie B. Multiple myeloma and chronic lymphocytic leukemia. Rev Invest Clin. 1997;49(Suppl 1):28–33.

    PubMed  Google Scholar 

  8. Singhal S, Mehta J, Desikan R, Ayers D, Roberson P, Eddlemon P, et al. Antitumor activity of thalidomide in refractory multiple myeloma. N Engl J Med. 1999;341:1565–71.

    Article  PubMed  CAS  Google Scholar 

  9. Richardson PG, Barlogie B, Berenson J, Singhal S, Jagannath S, Irwin D, et al. A phase 2 study of bortezomib in relapsed, refractory myeloma. N Engl J Med. 2003;348:2609–17.

    Article  PubMed  CAS  Google Scholar 

  10. Dimopoulos M, Spencer A, Attal M, Prince HM, Harousseau JL, Dmoszynska A, et al. Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma. N Engl J Med. 2007;357:2123–32.

    Article  PubMed  CAS  Google Scholar 

  11. Weber DM, Chen C, Niesvizky R, Wang M, Belch A, Stadtmauer EA, et al. Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America. N Engl J Med. 2007;357:2133–42.

    Article  PubMed  CAS  Google Scholar 

  12. Kumar SK, Rajkumar SV, Dispenzieri A, Lacy MQ, Hayman SR, Buadi FK, et al. Improved survival in multiple myeloma and the impact of novel therapies. Blood. 2008;111:2516–20.

    Article  PubMed  CAS  Google Scholar 

  13. van Rhee F, Dhodapkar M, Shaughnessy JD Jr, Anaissie E, Siegel D, Hoering A, et al. First thalidomide clinical trial in multiple myeloma: a decade. Blood. 2008;112:1035–8.

    Article  PubMed  Google Scholar 

  14. Brenner H, Gondos A, Pulte D. Recent major improvement in long-term survival of younger patients with multiple myeloma. Blood. 2008;111:2521–6.

    Article  PubMed  CAS  Google Scholar 

  15. Kastritis E, Zervas K, Symeonidis A, Terpos E, Delimbassi S, Anagnostopoulos N, et al. Improved survival of patients with multiple myeloma after the introduction of novel agents and the applicability of the International Staging System (ISS): an analysis of the Greek Myeloma Study Group (GMSG). Leukemia. 2009;23:1152–7.

    Article  PubMed  CAS  Google Scholar 

  16. San Miguel JF, Schlag R, Khuageva NK, Dimopoulos MA, Shpilberg O, Kropff M, et al. Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Engl J Med. 2008;359:906–17.

    Article  PubMed  CAS  Google Scholar 

  17. Brenner H, Gondos A, Pulte D. Expected long-term survival of patients diagnosed with multiple myeloma in 2006–2010. Haematologica. 2009;94:270–5.

    Article  PubMed  Google Scholar 

  18. Kristinsson SY, Landgren O, Dickman PW, Derolf AR, Bjorkholm M. Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. J Clin Oncol. 2007;25:1993–9.

    Article  PubMed  Google Scholar 

  19. Goldschmidt H, Hegenbart U, Wallmeier M, Moos M, Haas R. High-dose chemotherapy in multiple myeloma. Leukemia. 1997;11(Suppl 5):S27–31.

    PubMed  CAS  Google Scholar 

  20. Alexanian R, Dimopoulos M. The treatment of multiple myeloma. N Engl J Med. 1994;330:484–9.

    Article  PubMed  CAS  Google Scholar 

  21. Berenson JR, Rajdev L, Broder M. Bone complications in multiple myeloma. Cancer Biol Ther. 2006;5:1082–5.

    Article  PubMed  Google Scholar 

  22. Saad F, Lipton A, Cook R, Chen YM, Smith M, Coleman R. Pathologic fractures correlate with reduced survival in patients with malignant bone disease. Cancer. 2007;110:1860–7.

    Article  PubMed  Google Scholar 

  23. Alberts SR, Lanier AP. Leukemia, lymphoma, and multiple myeloma in Alaskan natives. J Natl Cancer Inst. 1987;78:831–7.

    PubMed  CAS  Google Scholar 

  24. Swan J, Edwards BK. Cancer rates among American Indians and Alaska Natives: is there a national perspective. Cancer. 2003;98:1262–72.

    Article  PubMed  Google Scholar 

  25. Benjamin M, Reddy S, Brawley OW. Myeloma and race: a review of the literature. Cancer Metastasis Rev. 2003;22:87–93.

    Article  PubMed  CAS  Google Scholar 

  26. Waxman AJ, Mink PJ, Devesa SS, Anderson WF, Weiss BM, Kristinsson SY, et al. Racial disparities in incidence and outcome in multiple myeloma: a population-based study. Blood. 2010;116:5501–6.

    Article  PubMed  CAS  Google Scholar 

  27. Rajkumar SV, Blood E, Vesole D, Fonseca R, Greipp PR. Phase III clinical trial of thalidomide plus dexamethasone compared with dexamethasone alone in newly diagnosed multiple myeloma: a clinical trial coordinated by the Eastern Cooperative Oncology Group. J Clin Oncol. 2006;24:431–6.

    Article  PubMed  CAS  Google Scholar 

  28. Wang M, Dimopoulos MA, Chen C, Cibeira MT, Attal M, Spencer A, et al. Lenalidomide plus dexamethasone is more effective than dexamethasone alone in patients with relapsed or refractory multiple myeloma regardless of prior thalidomide exposure. Blood. 2008;112(12):4445–51.

    Google Scholar 

  29. Mateos MV, Richardson PG, Schlag R, Khuageva NK, Dimopoulos MA, Shpilberg O, et al. Bortezomib plus melphalan and prednisone compared with melphalan and prednisone in previously untreated multiple myeloma: updated follow-up and impact of subsequent therapy in the phase III VISTA Trial. J Clin Oncol. 2010;28(13):2259–66.

    Google Scholar 

  30. Kuhn DJ, Chen Q, Voorhees PM, Strader JS, Shenk KD, Sun CM, et al. Potent activity of carfilzomib, a novel, irreversible inhibitor of the ubiquitin-proteasome pathway, against preclinical models of multiple myeloma. Blood. 2007;110:3281–90.

    Article  PubMed  CAS  Google Scholar 

  31. Lacy MQ, Hayman SR, Gertz MA, Dispenzieri A, Buadi F, Kumar S, et al. Pomalidomide (CC4047) plus low-dose dexamethasone as therapy for relapsed multiple myeloma. J Clin Oncol. 2009;27:5008–14.

    Article  PubMed  CAS  Google Scholar 

  32. David E, Sinha R, Chen J, Sun SY, Kaufman JL, Lonial S. Perifosine synergistically enhances TRAIL-induced myeloma cell apoptosis via up-regulation of death receptors. Clin Cancer Res. 2008;14:5090–8.

    Article  PubMed  CAS  Google Scholar 

  33. Erlichman C. Tanespimycin: the opportunities and challenges of targeting heat shock protein 90. Expert Opin Investig Drugs. 2009;18:861–8.

    Article  PubMed  CAS  Google Scholar 

  34. Fionda C, Soriani A, Malgarini G, Iannitto ML, Santoni A, Cippitelli M. Heat shock protein-90 inhibitors increase MHC class I-related chain A and B ligand expression on multiple myeloma cells and their ability to trigger NK cell degranulation. J Immunol. 2009;183:4385–94.

    Article  PubMed  CAS  Google Scholar 

  35. Richardson P, Mitsiades C, Colson K, Reilly E, McBride L, Chiao J, et al. Phase I trial of oral vorinostat (suberoylanilide hydroxamic acid, SAHA) in patients with advanced multiple myeloma. Leuk Lymphoma. 2008;49(3):502–7.

    Google Scholar 

  36. Ocio EM, Vilanova D, Atadja P, Maiso P, Crusoe E, Fernández-Lázaro D, et al. In vitro and in vivo rationale for the triple combination of panobinostat (LBH589) and dexamethasone with either bortezomib or lenalidomide in multiple myeloma. Haematologica. 2010;95(5):794–803.

    Google Scholar 

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Acknowledgments

We would like to acknowledge Rachel Garman and the entire Cancer Care Northwest research staff for their contributions to this manuscript.

Conflict of interest

The authors declare no competing financial interests.

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Authors and Affiliations

  1. Inland Northwest Myeloma/Lymphoma & Transplant Program of Cancer Care Northwest, Cancer Care Northwest, 601 S. Sherman Street, Spokane, WA, 99202, USA

    Hakan Kaya, Irfan Jawed, Danko Martincic, Ameer L. Elaimy, Wayne T. Lamoreaux, Robert K. Fairbanks, Kevin A. Weeks & Christopher M. Lee

  2. DataWorks Northwest, LLC, Coeur D’Alene, ID, USA

    Benjamin Peressini

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  1. Hakan Kaya
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Correspondence to Hakan Kaya.

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Kaya, H., Peressini, B., Jawed, I. et al. Impact of age, race and decade of treatment on overall survival in a critical population analysis of 40,000 multiple myeloma patients. Int J Hematol 95, 64–70 (2012). https://doi.org/10.1007/s12185-011-0971-z

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  • DOI: https://doi.org/10.1007/s12185-011-0971-z

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