Decrease in early mortality for newly diagnosed multiple myeloma patients in the Netherlands: a population-based study

Abstract

Identification of risk factors for early mortality (EM) in multiple myeloma (MM) patients may contribute to different therapeutic approaches in patients at risk for EM. This population-based study aimed to assess trends in EM and risk factors for EM among MM patients diagnosed in the Netherlands. All MM patients, newly diagnosed between 1989 and 2018, were identified in the Netherlands Cancer Registry. Patients were categorized into three calendar periods (1989-1998, 1999-2008, 2009-2018) and into five age groups (≤65, 66-70, 71-75, 76-80, >80 years). EM was defined as death by any cause ≤180 days post-diagnosis. We included 28,328 MM patients (median age 70 years; 55% males). EM decreased from 22% for patients diagnosed in 1989-1998 to 13% for patients diagnosed in 2009-2018 (P < 0.01) and this decrease was observed among all age groups. Exact causes of death could not be elucidated. Besides patient's age, we found that features related to a more aggressive disease presentation, and patient characteristics reflecting patients' physical condition were predictive of EM. In summary, EM decreased from 1999 onwards. Nevertheless, EM remains high, especially for patients aged >70 years. Therefore, novel strategies should be explored to improve the outcome of patients at risk for EM.

Fig. 1. Trends in relative survival and early mortality of patients with multiple myeloma (MM) in the Netherlands, 1989–2018.

A shows the trend in early mortality ≤180 days post-diagnosis according to age for the three consecutive calendar periods (1989–1998, 1999–2008, and 2009–2018). The absolute numbers of patient with early mortality ≤180 days post-diagnosis and the total number of patients per age group and calendar period are presented in the table below. B shows the 5-year relative survival estimates for MM patients diagnosed between January 1, 1989 and December 31, 2018 according to age. The absolute numbers of patients alive at 5 years post-diagnosis and the total number of patients per age group and calendar period are presented in the table below.

Fig. 2. First-line treatment of patients with multiple myeloma (MM) in the Netherlands, 2014–2018.

A shows the proportions of MM patients who never received first-line treatment, who were offered a watch-and-wait-approach, or who received anti-MM treatment, according to occurrence of EM and age at diagnosis. B shows the type of first-line regimen (regimen containing 1, 2, 3, or no novel agents) for newly diagnosed MM patients who started anti-MM treatment, according to occurrence of EM and age at diagnosis.