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Utilization of radiation therapy in multiple myeloma: trends and changes in practice

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Abstract

Plasma cell disorders including plasmacytomas and multiple myeloma (MM) are exquisitely radiosensitive, and thus, radiation therapy (XRT) is used effectively in their management. The role of XRT in the setting of novel MM therapeutics has not been explored. The 2016 National Cancer Database (NCDB) for MM with patients diagnosed between 2004 and 2013 was studied. Association between utilization of XRT as part of initial therapy and patient, disease, or treating facility characteristics was studied. A total of 111,281 cases with 91.6% MM, 7% osseous plasmacytoma (PLA-O), and 1.4% extramedullary plasmacytoma (PLA-E) were identified. XRT was utilized as part of initial therapy in 25.4% cases, including 69.3% of PLA-O, 60% of PLA-E, and 21.5% of MM patients. Patients with PLA-E and MM were significantly less likely to receive XRT as compared to PLA-O (p < 0.001). A significantly decreased use of XRT was noted over time (p < 0.001), and for advancing patient age (p < 0.001), women (p < 0.001), and blacks (p < 0.001), and with increasing income (p = 0.015). Patients with Medicare were less likely to receive XRT (OR 0.86, 95% CI 0.78, 0.94) as compared to uninsured as were those with initial treatment at academic or high-volume facilities and facilities performing stem cell transplant. There was overall decreased utilization of XRT in recent years, possibly due to advent of efficacious systemic agents for MM therapy, with a higher XRT utilization for plasmacytomas. Patterns of XRT use need to be explored prospectively, so that uniform standards of healthcare delivery can be maintained and treatment heterogeneity can be minimized.

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Authors and Affiliations

  1. Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    Sikander Ailawadhi, Meghna Ailawadhi, Zahara Kanji, Prachi Jani, Mays Abdulazeez, Salman Ahmed, Chander Shekher Aggarwal, Vivek Roy, Victoria R. Alegria, Asher Chanan-Khan & Taimur Sher

  2. Division of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA

    Sikander Ailawadhi & Aneel Paulus

  3. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA

    Ryan Frank

  4. Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA

    Mark Fiala

  5. Department of Hematology-Oncology, West Virginia Cancer Institute, Morgantown, WV, USA

    Sonikpreet Aulakh

  6. Department of Health Science Research, Mayo Clinic, Jacksonville, FL, USA

    David Hodge

  7. Hematology-Oncology, St. Vincent’s Cancer Center, Jacksonville, FL, USA

    Asher Chanan-Khan

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  1. Sikander Ailawadhi
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  2. Ryan Frank
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Correspondence to Sikander Ailawadhi.

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The authors declare that they have no conflicts of interest.

Research involving human participants and/or animals

Not applicable, the study was IRB exempt.

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Not applicable. No informed consent was obtained as anonymized aggregate data was obtained from NCDB as per their guidelines and application process (https://www.facs.org/quality-programs/cancer/ncdb/puf).

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Ailawadhi, S., Frank, R., Ailawadhi, M. et al. Utilization of radiation therapy in multiple myeloma: trends and changes in practice. Ann Hematol 100, 735–741 (2021). https://doi.org/10.1007/s00277-020-04371-1

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