A retrospective analysis of patient records from the National Cancer Database indicated that use of upfront radiation therapy (RT) for multiple myeloma (MM) was associated with a poorer prognosis. Results of this study were reported in the American Journal of Hematology.

The study was based on records from 2004 to 2015 of adults treated for MM with chemotherapy in the first 90 days postdiagnosis. Patients were categorized based on whether they received upfront RT for MM, administered between 90 days before and 14 days after beginning initial chemotherapy.

The study authors reported that out of the dataset of records from 78,095 patients with a median age of 65 years, 13,501 (17.3%) with newly diagnosed MM received upfront RT. When administered, upfront RT was given at a median of 14 days (range, 0-100) following diagnosis of MM.

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Overall survival (OS) was worse for patients receiving upfront RT. In an unadjusted comparison, upfront RT was associated with a median OS of 3.6 years, compared with 4.2 years for patients who did not receive upfront RT. The 3-year OS rate was 55.5% with upfront RT and 59.7% without it. With upfront RT, the adjusted hazard ratio for poorer survival was 1.11 (95% CI, 1.08-1.14; P <.0001).

The trend of worse survival with upfront RT persisted among patients who survived for more than a year following diagnosis and for those who underwent autologous stem cell transplantation. Poorer outcomes were also present for patients who had upfront RT in the 14 days after starting chemotherapy instead of before chemotherapy.

Use of upfront RT was higher in community hospitals compared with academic settings, and its use was inversely related to median income. Between 2010 and 2015 there was a decrease in the use of upfront RT.

Although upfront RT was associated with poorer prognosis in this population, the authors suggested that upfront RT may have been given to patients with more advanced or aggressive disease states, but such information was not available.


  1. Orcutt X, Barth P, Olszewski AJ. Prognostic significance of upfront radiation therapy in patients with multiple myeloma [published online April 21, 2019]. Am J Hematol. doi:10.1002/ajh.25492