Dramatic gains in survival seen in myeloma since early 2000s: Analysis
But awareness now needed on other new mortality risks for patients
Survival outcomes for people with multiple myeloma have improved substantially over the last two decades, likely due to the availability of new, more effective treatments, according to a population-based study from Germany.
Myeloma itself was the most common cause of death. But the new data also showed that people with myeloma are about twice as likely to die from non-myeloma cancers or heart disease compared with the general population.
“As survival improves, it is important that physicians become more aware of comorbidities [co-occurring health problems] and non-myeloma mortality risks emerging within the course of MM [multiple myeloma],” the researchers wrote.
With the use of cancer treatments and immunomodulatory therapies that target the body’s immune system, “the risk of secondary primary malignancies (SPM) as well as the risk of fatal outcomes due to late-occurring side effects and cumulative toxicity might increase,” the team wrote.
The study, “Time trends in survival and causes of death in multiple myeloma: a population-based study from Germany,” was published in BMC Cancer.
Survival in myeloma increases by 70%, per analysis
While there’s no cure for myeloma, new treatments have substantially improved outcomes for patients over the past 20 years. However, “whether survival benefits are evident outside of clinical trials” remains largely unclear, the researchers wrote. There’s also a lack of data on the risk of death associated with age-related conditions and treatment-related toxicity and side effects.
To learn more, a team of researchers in Germany assessed how survival outcomes have changed for people with myeloma since the start of the 21st century. The researchers sought to determine the main causes of death in these times of prolonged survival.
Using the largest population-based cancer registry in Germany, the scientists analyzed survival data from a total of 12,849 people who were diagnosed with multiple myeloma between 1995 and 2019. All patients were younger than age 80 at diagnosis.
To assess outcomes, the team calculated a measure called relative survival, or RS, in five-year periods: 2000 to 2004, 2005 to 2009, 2010 to 2014, and 2015 to 2019. This measure basically represents the chance of survival for someone with myeloma, compared with someone of a similar age in the general population.
“To our knowledge, this is the first study reporting estimates of conditional RS in MM in the era of effective multidrug therapies,” the researchers wrote.
The first analysis included 3,336 patients diagnosed between 1995 and 2019. Results showed a significant increase in five-year RS over time: from 36.7% in the early 2000s, up to 62.4% at the end of the 2010s.
The findings were similar for men and women. Overall, survival rates tended to be lower among patients ages 70-79 years (23.4% to 46.8%), but the increase in RS over time was comparable between patients older versus younger than age 70.
“The results from this population-based study show that over the past twenty years, age-standardised 5-year relative survival of patients with [myeloma] under the age of eighty remarkably increased,” the researchers wrote. Specifically, the increase was 70%.
The second analysis included 9,513 people diagnosed with multiple myeloma between 2010 and 2019. Results from this larger group showed a similar five-year RS (60.6%) for the 2015-2019 period.
“As several new substances for MM treatment have been introduced in the last 5-10 years, information on survival in recent years is of particular interest to clinicians,” the researchers wrote.
“Our survival analysis covering the period 2015–2019 necessarily includes data from patients diagnosed and treated before 2015, thus, survival will likely be underestimated,” they added.
Other cancers, heart disease found as common causes of death
Available data also showed that most patients (76.8%) died due to myeloma itself. However, non-myeloma cancer and cardiovascular diseases also were common causes of death, collectively accounting for more than 1 of every 10 deaths.
Our findings raise awareness of long-term risks and toxicities [of treatment], highlighting the particular role of intensified monitoring and screening as well as prevention measures in this patient collective.
Statistical analyses suggested that rates of death due to non-myeloma cancer or heart disease were about twice as high among myeloma patients compared with what would be expected in the general population.
Myeloma patients also were more likely than the general population to die from infections, gastrointestinal conditions, and hormonal, nutrition, or metabolic problems. There also were more deaths due to genitourinary system diseases, or those affecting the urinary and genital organs.
“Our findings raise awareness of long-term risks and toxicities [of treatment], highlighting the particular role of intensified monitoring and screening as well as prevention measures in this patient collective,” the researchers wrote.
Among the study’s limitations, the team noted the lack of data on treatment patterns used among patients in the databases. As such, “evidence about the impact of new therapies on survival is merely indirect,” they wrote.
Still, “the number and the efficacy of therapeutic substances for MM has increased dramatically,” the researchers wrote, adding that in recent years, trial results “have shown that the use of novel agents, targeted therapies, and multidrug regimens in patients with MM has led to improvements of overall survival.”
“These improvements are consistent with the ongoing increase of RS since the years 2000–2004 shown in the data presented here,” they added.
Overall, these findings indicate that “prognosis of patients with MM has markedly improved since the year 2000 due to therapeutic advances,” but “late mortality remains a major concern,” the researchers wrote.
“As survival improves, second primary malignancies and cardiovascular events deserve increased attention,” they concluded.
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