Patterns of improved survival in patients with multiple myeloma in the twenty-first century: a population-based study

Abstract

PURPOSE Randomized multiple myeloma (MM) studies show improved response rates and better progression-free survival for newer therapies. However, a less pronounced effect has been found for overall survival (OS). Using population-based data including detailed treatment information for individual patients, we assessed survival patterns for all patients diagnosed with MM in Malmö, Sweden from 1950 to 2005. PATIENTS AND METHODS We identified 773 patients with MM (48% males). On the basis of the age limit used for treatment with high-dose melphalan with autologous stem-cell support (HDM-ASCT; < or = 65 years old) in Sweden, we constructed Kaplan-Meier curves and used the Breslow generalized Wilcoxon test to evaluate OS patterns (diagnosed in six calendar periods) for patients 65 years old or younger and patients older than 65 years. Results Including all age groups, patients diagnosed from 1960 to 1969 had a better survival than patients diagnosed from 1950 to 1959. In subsequent 10-year calendar periods, median OS increased from 24.3 to 56.3 months (P = .036) in patients < or = 65 years old. In contrast, OS did not improve among patients older than age 65 years (21.2 to 26.7 months, P = .7). CONCLUSION With the establishment of HDM-ASCT as the standard therapy for younger patients with MM, OS has improved significantly for this age group in the general MM population. With novel therapies being commonly used at disease progression, presumably it becomes increasingly difficult to confirm survival differences between defined induction, consolidation, and maintenance therapies in the future. Consequently, in the era of novel MM therapies, population-based studies will serve as a necessary complement to randomized trials.

Fig 1.

Overall survival in patients with multiple myeloma according to date of diagnosis and age at diagnosis: (A) ≤ 65 years old (n = 242) and (B) > 65 years old (n = 431). Periods of diagnosis were as follows: 1 = 1950 to 1959; 2 = 1960 to 1969; 3 = 1970 to 1979; 4 = 1980 to 1989; 5 = 1990 to 1999; and 6 = 2000 to 2005.