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ASH 2011: Dr. Kapoor - Survival Outcome of Young Multiple Myeloma (MM) Patients in the Era of Novel Therapies
Prashant Kapoor, MD
Mayo Clinic
Rochester, Minnesota, USA
12.01.11

Background: The median age of patients diagnosed with MM is approximately 70 years, and it is a relatively uncommon disease in the younger population. Both conventional chemotherapy and stem cell transplantation (SCT) have favorably impacted the overall survival (OS) of young MM patients. The median survival of patients < 40 years of age, diagnosed prior to 1993 was reportedly 54 months at our institution. However, the impact of novel agents in this patient population is not well known. We studied the outcome of young patients presenting to our institution over the last decade.

Methods: Records of 1538 patients presenting between 01/99 to12/08 were reviewed. The demographics, features and therapeutic interventions in patients up to 45 years of age at diagnosis were analyzed using descriptive statistics. The survival outcome of this group was compared with the remainder of the cohort using the Kaplan-Meier method.

Results: One-hundred (6.5%) out of 1538 newly diagnosed MM patients were ≤ 45 years of age at diagnosis. The median follow-up of this group of young patients was 86 months. The disease and patient characteristics are outlined in table 1. A median of 5 regimens (range 1-14) was administered, and 85% patients had received high-dose therapy. 15 patients underwent allogeneic SCT after at least one prior autologous SCT. Novel agents were used both in the front-line and relapsed setting (lenalidomide 60%, thalidomide 56%, pomalidomide 9% and bortezomib 49%), and 45% of initial regimens were novel agent based. The 5 and 7-year OS from diagnosis was 69% and 59%, respectively and the median OS was 93 months. In contrast, the median OS of patients >45 years diagnosed during this period was 53 months (P=0.001, figure 1).

Conclusion: A marked improvement in OS of young patients with MM diagnosed in the novel agent era is noted in comparison to the historical control of similar age group. In addition, the age associated survival benefit in the younger patient population prevails in the era of novel therapies.

Table 1: Baseline characteristics of young, newly diagnosed myeloma patients

 

Parameter

No. of  Evaluable Patients

Values

Range

Age (years)

100

Median 41.3

22-45

Gender (M:F)

100

1.2:1

 

Hemoglobin (g/dl)

96

Median 11.1

5-15.6

Calcium (mg/dl)

81

Median 9.5

8.2-16

Creatinine

82

Median 1.1

0.4-16.2

Beta 2 microglobulin

85

Median 2.8

0.1-36

Albumin

71

Median 3.7

1.8-5.5

ISS

1

2

3

66

 

 

33 (50 %)

14 (21 %)

19 (29 %)

 

Kappa vs. Lambda

98

1.6:1

 

Bone marrow PCs (%)

98

40

1-95

Cytogenetics

64

Abnormal 8 (12.5%)

 

FISH

38

Abnormal 30 (79%)

 

PCLI(%)

PCLI ≥1

PCLI ≥3

64

 

 

Median 0.4

19 (30%)

5 (8%)

0-7

Mayo Risk Stratification

42

High risk 12 (29%)

 

Plasmacytoma(s)

100

34

 

AL amyloidosis

 

15

 

Performance Status (≥2)

86

10 (12%)

 

Abbreviations: M male, F female, ISS International staging system, PCs plasma cells, PCLI plasma cell labeling index  

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