Factors for Predicting Outcomes in Multiple Myeloma Vary Based on Age
Results of a recent study showed that the prognostic implications of patient-specific and tumor biological features vary significantly across age-groups of patients with multiple myeloma.
The study will be presented at the 59th Annual American Society of Hematology Meeting and Exposition (December 9-12, 2017; Atlanta, GA).
High-risk multiple myeloma is characterized by phenotype and associated progression and death rates. In younger patients, tumor acquired genetic changes—such as cytogenetic lesions t4 and t14 as well as del17p—are known to correlate with early disease progression and death. Outcomes in older patients are influenced by these genetic mutations, but also by other features such as age, physical function, and comorbidities.
Alina Striha, MSc, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research (United Kingdom), and colleagues conducted a study to examine both patient-specific and tumor acquired characteristics by age and their impact on outcomes across patients of varying ages. The study (Myeloma XI) sampled 3894 patients who were assigned to receive either cyclophosphamide, lenalidomide, and dexamethasone (CRD) or a similar combination with thalidomide (CTD). Researchers summarized important variables by age group (< 50, 51-60, 71-80, > 80) and a multivariate Cox regression analysis performed in each group was utilized to identify variables with the greatest effect on outcomes.
Researchers initially observed that neither progression-free survival (PFS) nor overall survival (OS) differed between patients aged < 50 years and those aged 51-60 years. However, PFS and OS decreased with each additionally age group thereafter.
Additionally, researchers reported that the proportion of patients with impaired performance status and those with changes in biomarkers of frailty increased substantially with age.
Furthermore, the biological and genetic features of disease changed significantly across age groups. While those aged < 50 years had an increased proportion of lgA subtype and decreased proportion of light chain only, the proportion of patients with t4, t14, and del17p lesions decreased significantly with age.
Multivariate Cox regression showed that cytogenetic-based risk stratification with advancing age had a lesser influence on PFS or OS compared to other factors.
Researchers concluded that differing age groups of patients with multiple myeloma may exhibit varying patient-specific and tumor acquired biological and genetic features, which is crucial to creating strategies for personalized treatment approaches. “Whereas the focus in younger patients should be on targeting high-risk disease biology, approaches to improve outcomes for older patients will require a focus on clinical variables and treatment modification strategies,” they wrote.—Zachary Bessette