Tx, Transplant Predict Multiple Myeloma Survival

NEW ORLEANS -- Only about one multiple myeloma patient in 13 will live more than 10 years, according to a database analysis.

But the chances of long-term survival are greater for patients treated at academic centers, according to Ronald Go, MD, of the Mayo Clinic in Rochester, Minn.

Patients also do better if they have an autologous stem cell transplant as part of their initial therapy, Go told MedPage Today before the analysis was presented at the annual meeting of the American Society of Hematology.

The findings come from analysis of theNational Cancer Data Base, a joint program of the Commission on Cancer, the American College of Surgeons, and the American Cancer Society, according to Go, who was senior author of the study.

It's the first attempt to try to tease out demographic factors that contribute to longer-term survival in multiple myeloma, a disease that almost always kills relatively quickly.

The researchers analyzed data for 27,987 patients diagnosed in 1998 through 2000, and divided them into four groups based on the median survival -- just 26.7 months at the time. Specifically:

• Cohort 1: Overall survival (OS) that was less than the median and included 55% of the patients
• Cohort 2: OS that was more than the median but less than twice the median with 19% of the patients
• Cohort 3: OS greater than twice the median but less than 10 years and included 18% of the patients
• Cohort 4: OS of 10 years or more with 8% of the patients

More than half the patients were male with a mean age at diagnosis of 67.2 years.

Analysis showed that several factors predicted long-term survival, Go said.

For instance, more than 10% of patients treated at academic centers fell into the long-term cohort 4, compared with about 5% treated at community cancer centers.

Similarly, more than 20% of those who had a stem cell transplant as part of initial therapy lived more than a decade, compared with about 5% of those who did not.

Younger age also predicted survival, although Go pointed out that older patients, even without disease, would be less likely to live a long time.

African Americans also did less well than whites, even though they are known to have better outcomes from multiple myeloma. That's probably a result of comorbidities such as high blood pressure and diabetes skewing the all-cause mortality statistics, Go said.

Sex, ethnicity, and place of residence had no apparent effects, the researchers found.

The study is "really quite striking," commented Noopur Raje, MD, of the Massachusetts General Hospital Cancer Center in Boston, who was not involved in the study.

"From a myeloma investigator's point of view," the interesting part of the study is that -- without going into the biological aspects of the disease -- Go and colleagues were able to pinpoint factors predicting survival, she told MedPage Today.

"What it really tells me is that some of [survival may have] to do with access to drugs and access to therapies," she said. Access to the latest treatments is more likely at academic centers, she noted.

The clinical implication for patients is that "if you have a center which focuses on this disease, go to that site," she said.

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