Early mortality following diagnosis of multiple myeloma from 2011 to 2016 in Alberta, Canada: Initial results from the population-based Identifying Outcomes in Real-World Multiple Myeloma (INFORMM) study.

Abstract

e19509 Background: The clinical outcomes of patients with newly diagnosed multiple myeloma (NDMM) have improved. However, early mortality (EM) post-diagnosis remains a concern, with incidence ranging from 13% at 2 months to 29% at 1 year after diagnosis. EM can be influenced by patient age, comorbidities, performance status, therapy, and disease biology. Our aim is to examine EM incidence in patients with NDMM and to describe variables that may influence EM in the era of novel chemotherapeutic agents using the INFORMM Study, an ongoing, province-wide real-world evidence study in Alberta, Canada. Methods: Using administrative health data in Alberta (population 4.32 million in 2018), we identified our study population from a validated algorithm of International Classification of Diseases-9 and -10 diagnostic codes. Additionally, the NDMM cohort was confirmed using bone marrow biopsy records, and patients who received therapy for myeloma were derived from the province-wide Pharmaceutical Information Network database. EM was defined as death by any cause within 90 days of diagnosis. Further analyses will be performed to explore potential risk factors associated with EM using regression modeling. Results: We identified 1,729 patients diagnosed with NDMM between 2011 and 2016. EM occurred in 185 patients (10.7%). Of the 185 patients who experienced EM, 156 (84.3%) were aged ≥ 65 years, 174 (94.1%) had a Charlson Comorbidity Index score ≥ 3, and 48 (25.9%) had infectious complications within 90 days of diagnosis. In addition, 99 (53.5%) patients received ≥ 1 anti-myeloma therapy regimen (lenalidomide-based = 5, bortezomib-based = 22, other = 72), whereas 86 (46.5%) did not receive any anti-myeloma therapy. Conclusions: Despite advances in chemotherapeutics and supportive care, patients with NDMM still have a high risk of EM. The higher EM incidence observed in older patients could be attributable to treatment toxicity, comorbidities, or issues surrounding delivery of suitable treatments. Clinicians should consider potential factors associated with EM in their care plan, including in serious illness conversations.