Comprehensive assessment (CA) of organ function and comorbidities in a large consecutive multiple myeloma patient cohort.

Abstract

e18523 Background: MM is a frequent hematological cancer, typically affecting elderly patients. Individualized disease management has substantially improved MM-outcome. The prognostic importance of comorbidities is increasingly recognized. We aimed to define which comorbidities substantially affect PFS and OS and which of various comorbidity scores is most valuable. Methods: We retrospectively assessed 466 consecutive MM patients treated in our department between 2003-2009. Comorbidity was scored via Kaplan Feinstein (KF), HCT-CI and KLeber-score (Karnofsky-index, lung function and eGFR). Treatment was given according to institutional/international guidelines with SCT in transplant-eligible patients, and standard-therapy plus novel agents in elderly patients. Results: Patients showed a median age of 62 years (range; 27-90). Increasing CKD stages (1->5) were associated with increased age (58->63years), increased D&S and ISS-stages (median ISS 2->3), reduced KI (90->70%), impaired organ- function, anemia (11.8->9.6g/dl) and hypoalbuminemia (3.8->3.2g/dl), whereas ß2-MG (3.2->23.6mg/dl), LDH (217->292U/l), HCT-CI (1->5) and KLeber-indices (1->2) increased. Univariate analysis determined moderate or severe pulmonary disease, RF, decreased KI, age >59years, secondary neoplasms (SN), adverse cytogenetics, ß2-MG, albumin, hemoglobin and LDH to significantly diminish PFS and OS. The KF-, HCT-CI- and KLeber-score led to significantly different OS rates of not reached (nr) vs. 57 months (ms; KF with 2 vs. 3 risk factors [rfs]), 135 vs. 53ms (HCT-CI with <1 vs. >1 rfs) and nr vs. 86 and 39ms (KLeber with 0, 1 vs. 2 or 3 rfs; log-rank test), respectively. Conclusions: Comorbidities in MM are frequent. Important prognostic determinants for diminished PFS and OS are pulmonary disease, impaired RF, decreased KI, age >59years, SN, adverse cytogenetics, ß2-MG, albumin, hemoglobin and LDH. With only 1-point-score difference, the KF, HCT-CI and KLeber-indices induced significant OS changes. Our results highlight the debate on CA which seems vastly useful to implement into future analyses and clinical trials. Our defined risk factors and comorbidity scores should prove decidedly valuable. No significant financial relationships to disclose.