A real‐world data analysis of predictors of early mortality after a diagnosis of multiple myeloma

• Published in: Cancer 2023-07, Vol.129 (13), p.2023-2034
• Main Authors: Grant, Shakira J., Wildes, Tanya M., Rosko, Ashley E., Silberstein, Juliet, Giri, Smith
• Format: Article
• Language: English
• Subjects: Adults; Aged; Data Analysis; Death; Diagnosis; Disease-Free Survival; early mortality; electronic health record; Electronic health records; Electronic medical records; Fatalities; Glomerular filtration rate; Humans; Medical diagnosis; Mortality; Multiple myeloma; Multiple Myeloma - drug therapy; older adults; Older people; Oncology; predictors; Proteasome inhibitors; Proteasomes; real‐world experience; Renal function; Retrospective Studies
• ISSN: 0008-543X; 1097-0142; 1097-0142
• DOI: 10.1002/cncr.34760

Background Despite the increased availability and use of novel therapies for multiple myeloma, early mortality is a pervasive challenge with a significant impact on older adults. Reported rates and predictors of early mortality have varied in the literature, with most studies seldom focusing on community‐treated patients. Methods In this retrospective cohort analysis of a real‐world electronic health record–derived deidentified database of 7512 patients newly diagnosed with multiple myeloma between January 1, 2011, and February 2, 2021, and treated primarily in US‐based community oncology practices, factors associated with early mortality (defined as death within 6 months after the multiple myeloma diagnosis) were examined with the use of binary logistic regression. Results The median age was 70 years overall. We found an overall early mortality rate of 8.3%, with 73% of early deaths occurring in those aged ≥70 years. Among the early deaths, only 49 patients (8.7%) had documented disease progression before death (median time to progression, 30 days [interquartile range, 7–53 days]). Baseline factors associated with higher odds of early mortality included an Eastern Cooperative Oncology Group performance status (ECOG PS) ≥ 2, Revised International Staging System (R‐ISS) stage III, an age ≥ 70 years, receipt of proteasome inhibitor–doublet therapy, a light‐chain isotype, and the presence of renal dysfunction (estimated glomerular filtration rate < 30 mL/min). Among those aged ≥70 years, ECOG PS ≥ 2 and R‐ISS stage III remained the strongest predictors of early mortality. Conclusions Early mortality disproportionately affects older adults (aged ≥70 years) with multiple myeloma. Interventions to support this population are needed to reduce disparate survival outcomes. Plain language summary Factors associated with an increased risk of dying within 6 months (early mortality) of a new diagnosis of multiple myeloma (MM) among 7512 mostly community‐treated patients with MM were evaluated. The early mortality rate was 8.3%; among those deaths, 49 patients (8.7%) had documented evidence of MM progression before death. The risk of early mortality was greatest for older patients (aged ≥70 years) and those with a poor performance status, poor kidney function, a higher disease stage, and light‐chain MM and those receiving two‐drug MM therapies. These findings highlight the need for supportive interventions geared toward older adults with MM. Approximately 9% of adults n