The impact of age and comorbidities on practice patterns and outcomes in patients with relapsed/refractory multiple myeloma in the era of novel therapies

https://doi.org/10.1016/j.jgo.2017.09.007Get rights and content
Under a Creative Commons license
open access

Abstract

Objectives

One-third of patients with multiple myeloma (MM) are diagnosed at age  75 years. Older patients have increased incidence of cardiovascular disease (CVD) and renal insufficiency (RI), hallmark complications of MM. We examined cumulative incidence of CVD and RI in relapsed/refractory MM (RRMM) and outcomes by age and RI/CVD.

Materials and Methods

Retrospective cohort study using a large US electronic medical records database of adult patients with RRMM initiating first- and second-line therapy (2LT) between 1/2008–06/2015. RI and CVD comorbidities were based on diagnosis codes and/or lab values.

Results

Among 628 patients, 37.1% were ≥ 75 years. Cumulative incidence of CVD and/or RI increased from 47.7% at MM diagnosis to 67.8% at first relapse. Age  75 years had a trend toward higher risk of relapse post 2LT, proxied by time to next treatment (TTNT), (adjusted HR: 1.28; 95% CI: 1.00, 1.65; P = 0.05). TTNT was significantly higher with comorbid CVD + RI (adjusted HR: 1.50; 95% CI: 1.11, 2.02; P < 0.01). Age  75 years, RI, CVD, and CVD + RI were associated with increased mortality risk from 2LT initiation; adjusted HR: 1.66 (95% CI: 1.19, 2.33; P < 0.01), 1.51 (95% CI: 1.01, 2.26; P = 0.04), 1.75 (95% CI: 1.03, 2.96; P = 0.04), and 1.95 (95% CI: 1.29, 2.93; P < 0.01), respectively.

Conclusion

Despite treatment with novel agents for RRMM in 86% of patients, an outcome gap persists for older patients and those with RI and/or CVD. Personalized treatment approaches that account for age and comorbidities, and further evaluation of innovative regimens and dosing schedules, are needed to improve outcomes for these patients.

Keywords

Relapsed/refractory multiple myeloma
Age
Elderly
Comorbidities
Retrospective analysis
Renal insufficiency
Cardiovascular disease
Treatment

Cited by (0)

1

A wholly owned subsidiary of Takeda Pharmaceutical Company Limited.