Evolution of Anti-Cancer Treatment and its Impact on Surrogate Prognostic Factors in Multiple Myeloma

Abstract

Aim. To assess prognostic value of surrogate clinical and laboratory markers in current therapy of multiple myeloma (MM). Materials & Methods. The analysis included 567 patients (215 men and 352 women), the Kirov region inhabitants with newly diagnosed MM over the period from January 1, 1994 to December 31, 2016. The median age was 64 years (range 29-90). Patients were divided into two groups: the first group received treatment from 1994 to 2005 (n = 269), the second group received treatment from 2006 to 2016 (n = 298). Impact of factors on overall survival (OS) was evaluated by multivariate logistic regression analysis using the Cox method. Results. Over the period from 2006 to 2016 the number of patients treated with traditional chemotherapy decreased from 78.4 to 32.5 %. At the same time the number of patients treated with bortezomib-based regimens increased from 1.9 to 56.3 % and autologous hematopoietic stem cell transplantation (auto-HSCT) protocols - from 1.4 to 14.0 %. Median OS over the period from 1994 to 2005 was 27 months. It increased to 55 months in the period of 2006-2016. In the reference decades 5-year overall survival increased from 21 % (95% confidence interval [95% CI] 17-27 %) to 47 % (95% CI 39-55 %), respectively (hazard ratio [HR] 0.51; 95% CI 0.41 0.64; p < 0,0001). In patients treated with bortezomib-based regimens over the period from 2006 to 2016 median OS increased to 73 months compared to 27 months in 19942005. In patients aged < 65 years and treated with auto-HSCT median OS was not reached, and median OS in patients without auto-HSCT treatment was 54 months. Conclusions. Surrogate prognostic markers, such as the age over 65, hemoglobin level < 100 g/L, ß2-microglobulin > 6 mg/L, serum creatinine > 177 pmol/L and stage III according to ISS and Durie-Salmon, are unfavourable predictors of survival of MM patients.