Patients with multiple myeloma (MM) had significant improvements in 5-year relative survival across all age groups since 1982, according to study results published in the British Journal of Haematology. The investigators noted that some improvements aligned with the historical introduction of treatment standards.
A team of investigators leveraged data from the Cancer Registry of Norway, which has required compulsory reporting of all cancer cases by the country’s hospitals, laboratories, and general practitioners since 1953. They also obtained nationwide myeloma drug consumption statistics from the Norwegian Institute of Public Health.
To investigate the country’s trends in incidence and relative survival in MM, the investigators separated all patients who were diagnosed with MM between 1982 and 2017 (excluding incidental MM diagnosed at death/autopsy or no follow up) into 3 age-based categories: younger than 65 years (transplant eligible), 65 to 79 years (youngest transplant ineligible) and aged 80 years or older (oldest transplant ineligible). Follow up for each patient continued until death, emigration, or the end of the study.
They then split the historical periods into 7 categories based on the introduction of treatment standards: 1982 to 1987 and 1988 to 1992 (melphalan-prednisone), 1993 to 1997 (early high-dose melphalan followed by autologous stem cell transplant), 1998 to 2002 (introduction of thalidomide), 2003 to 2007 (early thalidomide upfront, introduction of bortezomib), 2008 to 2012 (thalidomide and bortezomib upfront, introduction of lenalidomide), and 2013 to 2017 (lenalidomide upfront, early pomalidomide, daratumumab, panobinostat, and carfilzomib).
For the 10,524 patients included in the study, the median age at diagnosis was 71 years; 53.7% were men. The median follow up was 2.4 years with 8458 deaths and 10 emigrations.
The age-standardized incidence rate between 1982 and 2017 shifted from stable to increasing starting at approximately the year 2000. From 2014 to 2017, the incidence rate of MM standardized to the Norwegian population increased from 7.3 to 8.4. The authors suggested that these increases over time are likely attributable to increased use of certain biomarkers and diagnosis of smoldering MM.
For patients younger than 65 years, the 5-year and 10-year relative survival steadily increased over all time periods. For patients aged 65 to 79 years, both 5-year and 10-year relative survival were stable until approximately 1998 to 2002, corresponding to the introduction of thalidomide, after which both increased. For patients aged 80 years or older, the 5-year relative survival increased from the first to last time period from 0.11 to 0.28).
Some study limitations included that cancer registry did not differentiate between smoldering and active MM nor did it include individual information on clinical features, treatment, or biomarkers.
“In conclusion, we demonstrate a significant improvement in 5-year [relative survival] in all age groups. Improved [relative survival] in patients aged ≥80 years at the time of diagnosis is only rarely described in other population-based studies,” wrote the authors. “For patients aged ≥65 years, the improvement in [relative survival] coincides with the introduction of modern drugs, whereas patients aged <65 years had an ongoing improvement before the introduction of autologous stem-cell transplant.”
Langseth ØO, Myklebust TÅ, Johannesen TB, Hjertner Ø, Waage A. Incidence and survival of multiple myeloma: a population‐based study of 10 524 patients diagnosed 1982–2017 [published online May 5, 2020]. Br J Haematol. doi: 10.1111/bjh.16674