Abstract
The main goal was to find a simple prognostic to evaluate overall survival of patients older than 65 years of age with myeloma. Retrospective registry-based analysis from the Registry of Monoclonal Gammopathies was conducted. Patients over 65 years with symptomatic myeloma were included. The four major parameters with impact on survival were identified: male gender, age > 75, creatinine > 152 μmol/L, and ECOG performance status 2–4. The patients were scored as good (0 points), intermediate good (1 point), intermediate poor (2 points), poor (3–4 points). Patients (1410 MM) were included. Median OS (months) was 65.7 (95% CI 49.8–81.7) for good, 51.0 (44.1–57.8) for intermediate good, 32.2 (26.2–38.2) for intermediate poor, and 18.9 (15.1–22.7) for poor. The differences in OS were statistically significant (p < 0.0001). Good score was used as reference for hazard ratios, which for each other score were 1.43 (1.09–1.84) for intermediate good, 2.58 (2.00–3.33) for intermediate poor, and 3.88 (2.94–5.10) for poor. Time to progression showed medians (months) 20.5 (17.4–62.4) for good, 19.3 (17.0–21.7) for intermediate good, 19.6 (16.2–23.0) for intermediate poor, and 13.0 (10.8–15.2) for poor. The suggested scoring system provides readily available information about the prognosis of MM patients above 65 years.
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Palumbo A, Bringhen S, Ludwig H, Dimopoulos MA, Blade J, Mateos MV, Rosinol L, Boccadoro M, Cavo M, Lokhorst H, Zweegman S, Terpos E, Davies F, Driessen C, Gimsing P, Gramatzki M, Hajek R, Johnsen HE, Leal da Costa F, Sezer O, Spencer A, Beksac M, Morgan G, Einsele H, San Miguel JF, Sonneveld P (2011) Personalized therapy in multiple myeloma according to patient age and vulnerability: a report of the European myeloma network (EMN). Blood 118:4519–4529. https://doi.org/10.1182/blood-2011-06-358812
Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA (2009) Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 27:2758–2765. https://doi.org/10.1200/JCO.2008.20.8983
Zweegman S, Palumbo A, Bringhen S, Sonneveld P (2014) Age and aging in blood disorders: multiple myeloma. Haematologica 99:1133–1137. https://doi.org/10.3324/haematol.2014.110296
Greipp PR, San Miguel J, Durie BGM et al (2005) International staging system for multiple myeloma. J Clin Oncol 23:3412–3420. https://doi.org/10.1200/JCO.2005.04.242
Palumbo A, Avet-Loiseau H, Oliva S, Lokhorst HM, Goldschmidt H, Rosinol L, Richardson P, Caltagirone S, Lahuerta JJ, Facon T, Bringhen S, Gay F, Attal M, Passera R, Spencer A, Offidani M, Kumar S, Musto P, Lonial S, Petrucci MT, Orlowski RZ, Zamagni E, Morgan G, Dimopoulos MA, Durie BGM, Anderson KC, Sonneveld P, San Miguel J, Cavo M, Rajkumar SV, Moreau P (2015a) Revised international staging system for multiple myeloma: a report from International Myeloma Working Group. J Clin Oncol 33:2863–2869. https://doi.org/10.1200/JCO.2015.61.2267
Palumbo A, Bringhen S, Mateos M-V, Larocca A, Facon T, Kumar SK, Offidani M, McCarthy P, Evangelista A, Lonial S, Zweegman S, Musto P, Terpos E, Belch A, Hajek R, Ludwig H, Stewart AK, Moreau P, Anderson K, Einsele H, Durie BGM, Dimopoulos MA, Landgren O, San Miguel JF, Richardson P, Sonneveld P, Rajkumar SV (2015b) Geriatric assessment predicts survival and toxicities in elderly myeloma patients: an International Myeloma Working Group report. Blood 125:2068–2074. https://doi.org/10.1182/blood-2014-12-615187
Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist 9:179–186
Parmelee PA, Thuras PD, Katz IR, Lawton MP (1995) Validation of the cumulative illness rating scale in a geriatric residential population. J Am Geriatr Soc 43:130–137
Cheson BD, Bennett JM, Grever M, Kay N, Keating MJ, O'Brien S, Rai KR (1996) National Cancer Institute-sponsored working group guidelines for chronic lymphocytic leukemia: revised guidelines for diagnosis and treatment. Blood 87:4990–4997
Rajkumar SV, Harousseau J-L, Durie B, Anderson KC, Dimopoulos M, Kyle R, Blade J, Richardson P, Orlowski R, Siegel D, Jagannath S, Facon T, Avet-Loiseau H, Lonial S, Palumbo A, Zonder J, Ludwig H, Vesole D, Sezer O, Munshi NC, San Miguel J, on behalf of the International Myeloma Workshop Consensus Panel 1 (2011) Consensus recommendations for the uniform reporting of clinical trials: report of the international myeloma workshop consensus panel 1. Blood 117:4691–4695. https://doi.org/10.1182/blood-2010-10-299487
International Myeloma Working Group (2003) Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol 121:749–757
Barford A, Dorling D, Davey Smith G, Shaw M (2006) Life expectancy: women now on top everywhere. BMJ 332:808. https://doi.org/10.1136/bmj.332.7545.808
Seifarth JE, McGowan CL, Milne KJ (2012) Sex and life expectancy. Gend Med 9:390–401. https://doi.org/10.1016/j.genm.2012.10.001
Terebelo H, Srinivasan S, Narang M, Abonour R, Gasparetto C, Toomey K, Hardin JW, Larkins G, Kitali A, Rifkin RM, Shah JJ (2017) Recognition of early mortality in multiple myeloma by a prediction matrix. Am J Hematol 92:915–923. https://doi.org/10.1002/ajh.24796
Ludwig H, Durie BGM, Bolejack V, Turesson I, Kyle RA, Blade J, Fonseca R, Dimopoulos M, Shimizu K, San Miguel J, Westin J, Harousseau JL, Beksac M, Boccadoro M, Palumbo A, Barlogie B, Shustik C, Cavo M, Greipp PR, Joshua D, Attal M, Sonneveld P, Crowley J (2008) Myeloma in patients younger than age 50 years presents with more favorable features and shows better survival: an analysis of 10 549 patients from the International Myeloma Working Group. Blood 111:4039–4047. https://doi.org/10.1182/blood-2007-03-081018
Costa LJ, Brill IK, Omel J, Godby K, Kumar SK, Brown EE (2017) Recent trends in multiple myeloma incidence and survival by age, race, and ethnicity in the United States. Blood Adv 1:282–287. https://doi.org/10.1182/bloodadvances.2016002493
Costa LJ, Hari PN, Kumar SK (2016) Differences between unselected patients and participants in multiple myeloma clinical trials in US: a threat to external validity. Leuk Lymphoma 57:2827–2832. https://doi.org/10.3109/10428194.2016.1170828
Panitsas F, Kothari J, Vallance G, Djebbari F, Ferguson L, Sultanova M, Ramasamy K (2018) Treat or palliate: outcomes of very elderly myeloma patients. Haematologica 103:e32–e34. https://doi.org/10.3324/haematol.2017.173617
Dimopoulos MA, Cheung MC, Roussel M, Liu T, Gamberi B, Kolb B, Derigs HG, Eom H, Belhadj K, Lenain P, van der Jagt R, Rigaudeau S, Dib M, Hall R, Jardel H, Jaccard A, Tosikyan A, Karlin L, Bensinger W, Schots R, Leupin N, Chen G, Marek J, Ervin-Haynes A, Facon T (2016) Impact of renal impairment on outcomes with lenalidomide and dexamethasone treatment in the FIRST trial, a randomized, open-label phase 3 trial in transplant-ineligible patients with multiple myeloma. Haematologica 101:363–370. https://doi.org/10.3324/haematol.2015.133629
Hus I, Walter-Croneck A, Masternak A, Jurczyszyn A, Usnarska–Zubkiewicz L, Bołkun Ł, Druzd-Sitek A, Rymko M, Łętowska J, Lech-Marańda E, Pasiarski M, Dmoszyńska A (2017) Real-life experience with bortezomib-based regimens in elderly patients with newly diagnosed multiple myeloma and comorbidities: a Polish retrospective multicenter study. Pol Arch Intern Med 127:765–774. https://doi.org/10.20452/pamw.4099
Facon T, Dimopoulos MA, Dispenzieri A, Catalano JV, Belch A, Cavo M, Pinto A, Weisel K, Ludwig H, Bahlis NJ, Banos A, Tiab M, Delforge M, Cavenagh JD, Geraldes C, Lee JJ, Chen C, Oriol A, de la Rubia J, White D, Binder D, Lu J, Anderson KC, Moreau P, Attal M, Perrot A, Arnulf B, Qiu L, Roussel M, Boyle E, Manier S, Mohty M, Avet-Loiseau H, Leleu X, Ervin-Haynes A, Chen G, Houck V, Benboubker L, Hulin C (2017) Final analysis of survival outcomes in the randomized phase 3 FIRST trial. Blood 131:301–310. https://doi.org/10.1182/blood-2017-07-795047
Hulin C, Belch A, Shustik C, Petrucci MT, Dührsen U, Lu J, Song K, Rodon P, Pégourié B, Garderet L, Hunter H, Azais I, Eek R, Gisslinger H, Macro M, Dakhil S, Goncalves C, LeBlanc R, Romeril K, Royer B, Doyen C, Leleu X, Offner F, Leupin N, Houck V, Chen G, Ervin-Haynes A, Dimopoulos MA, Facon T (2016) Updated outcomes and impact of age with lenalidomide and low-dose dexamethasone or melphalan, prednisone, and thalidomide in the randomized, phase III FIRST trial. J Clin Oncol 34:3609–3617. https://doi.org/10.1200/JCO.2016.66.7295
Auner HW, Garderet L, Kröger N (2015) Autologous haematopoietic cell transplantation in elderly patients with multiple myeloma. Br J Haematol 171:453–462. https://doi.org/10.1111/bjh.13608
Palumbo A, Bringhen S, Petrucci MT, Musto P, Rossini F, Nunzi M, Lauta VM, Bergonzi C, Barbui A, Caravita T, Capaldi A, Pregno P, Guglielmelli T, Grasso M, Callea V, Bertola A, Cavallo F, Falco P, Rus C, Massaia M, Mandelli F, Carella AM, Pogliani E, Liberati AM, Dammacco F, Ciccone G, Boccadoro M (2004) Intermediate-dose melphalan improves survival of myeloma patients aged 50 to 70: results of a randomized controlled trial. Blood 104:3052–3057. https://doi.org/10.1182/blood-2004-02-0408
Facon T, Mary JY, Hulin C, Benboubker L, Attal M, Pegourie B, Renaud M, Harousseau JL, Guillerm G, Chaleteix C, Dib M, Voillat L, Maisonneuve H, Troncy J, Dorvaux V, Monconduit M, Martin C, Casassus P, Jaubert J, Jardel H, Doyen C, Kolb B, Anglaret B, Grosbois B, Yakoub-Agha I, Mathiot C, Avet-Loiseau H (2007) Melphalan and prednisone plus thalidomide versus melphalan and prednisone alone or reduced-intensity autologous stem cell transplantation in elderly patients with multiple myeloma (IFM 99-06): a randomised trial. Lancet Lond Engl 370:1209–1218. https://doi.org/10.1016/S0140-6736(07)61537-2
Merz M, Neben K, Raab MS, Sauer S, Egerer G, Hundemer M, Hose D, Kunz C, Heiß C, Ho AD, Goldschmidt H, Hillengass J (2014) Autologous stem cell transplantation for elderly patients with newly diagnosed multiple myeloma in the era of novel agents. Ann Oncol Off J Eur Soc Med Oncol 25:189–195. https://doi.org/10.1093/annonc/mdt509
Badros A, Barlogie B, Siegel E, Morris C, Desikan R, Zangari M, Fassas A, Anaissie E, Munshi N, Tricot G (2001) Autologous stem cell transplantation in elderly multiple myeloma patients over the age of 70 years. Br J Haematol 114:600–607
Dhakal B, Nelson A, Guru Murthy GS, Fraser R, Eastwood D, Hamadani M, Pasquini M, D'Souza A, Hari P (2017) Autologous hematopoietic cell transplantation in patients with multiple myeloma: effect of age. Clin Lymphoma Myeloma Leuk 17:165–172. https://doi.org/10.1016/j.clml.2016.11.006
Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG, Storer B (2005) Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 106:2912–2919. https://doi.org/10.1182/blood-2005-05-2004
Kaplan MH, Feinstein AR (1974) The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. J Chronic Dis 27:387–404
Engelhardt M, Dold SM, Ihorst G, Zober A, Moller M, Reinhardt H, Hieke S, Schumacher M, Wasch R (2016) Geriatric assessment in multiple myeloma patients: validation of the international myeloma working group (IMWG) score and comparison with other common comorbidity scores. Haematologica 101:1110–1119. https://doi.org/10.3324/haematol.2016.148189
Engelhardt M, Domm A-S, Dold SM, Ihorst G, Reinhardt H, Zober A, Hieke S, Baayen C, Müller SJ, Einsele H, Sonneveld P, Landgren O, Schumacher M, Wäsch R (2017) A concise revised myeloma comorbidity index as a valid prognostic instrument in a large cohort of 801 multiple myeloma patients. Haematologica 102:910–921. https://doi.org/10.3324/haematol.2016.162693
Maisnar V, Pelcová J, Klimeš D et al (2011) RMG—registry of monoclonal gammopathies. Onkologie 5:138–140
Radocha J, Pour L, Spicka I, et al (2015) Registry of monoclonal gammopathies (RMG) in the Czech Republic. Blood 126
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Supported by program PROGRES Q40/08 and by MH CZ-DRO (UHHK, 00179906). The authors are grateful to Ian McColl MD, PhD for assistance with the manuscript.
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JR designed the study, analyzed the outcomes, and wrote the manuscript.
RH wrote, reviewed, and approved the manuscript.
LB did all statistical analysis and wrote and reviewed the manuscript.
LP reviewed and approved the manuscript.
IŠ reviewed and approved the manuscript.
JM reviewed and approved the manuscript.
EG reviewed and approved the manuscript.
AJ reviewed and approved the manuscript.
TJ reviewed and approved the manuscript.
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Radocha, J., Hájek, R., Brožová, L. et al. Simplified novel prognostic score for real-life older adults with multiple myeloma—registry-based analysis. Ann Hematol 98, 951–962 (2019). https://doi.org/10.1007/s00277-018-3568-2
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DOI: https://doi.org/10.1007/s00277-018-3568-2