Presenting Characteristics and Symptom Burden of Newly Diagnosed Older Multiple Myeloma Patients in the Commpass Study

Abstract

Background: Multiple myeloma (MM) is a disease of older adults, with a median age of diagnosis in the late 60s. While treatment advances have prolonged overall survival (OS) in MM, improvements have been modest among older MM patients. Symptom burden and quality of life are concerns for older patients, as they are more susceptible to treatment intolerance and dose reduction or treatment cessation. Older patients are often under-represented in clinical trials, and less information is available regarding their presenting clinical characteristics and treatment course.The Multiple Myeloma Research Foundation (MMRF) CoMMpass study, is a multicenter study in newly diagnosed multiple myeloma. It collects clinical-molecular data and patient reported health-related quality of life measures (EORTC QLQ-C30 and EORTC QLQ-MY20). In this study, we analyzed data from the CoMMpass study and compared presenting clinical characteristics, symptom burden and genetic features of newly diagnosed MM patients ≥ 75 years of age and those < 75 years of age. An additional analysis of t(4;14) was performed among those aged <65 years, 65-75 years and > 75 years to confirm prior observations that the incidence of t(4;14) decreases with age (Avet-Loiseau et al. 2013).Methods: Clinical data from the interim analysis 6 of the CoMMpass study was extracted via the MMRF Researcher Gateway. CoMMpass eligibility requirements include: symptomatic MM with measureable disease by SPEP (≥1.0g/dL), UPEP (≥200mg/24 hours), or SFLC (≥10mg/dL); receiving an immunomodulator and/or a proteasome inhibitor for initial MM treatment; and no prior malignancies in the past 5 years.Enrollment began in July 2011. Clinical data is recorded at enrolling centers by data analysts. Analysis was with STATA 12.0. Categorical variables were compared with χ2; continuous variables were compared with student's t-tests and Wilcoxon rank-sum tests.Results: 625 patients were eligible for analysis. 92 patients were ≥ 75 years of age, and 533 were < 75 years of age. Median ages were 80 years (range 75-93) and 63 years (range 27-74). Distribution of sex and race were evenly divided. Older patients had higher rates of International staging system (ISS), stage III disease at presentation. Baseline measurements of creatinine, platelet counts and hemoglobin were worse for older patients. On symptom and quality of life assessment, older patients were more likely to have difficulties with physical functioning, and were less likely to have difficulties with emotional functioning or finances. Subset analysis of those aged < 65 years, 65-75 years and > 75 years showed a trend towards decreasing rates of t(4;14).Results are summarized in Table 1.Conclusion: Older patients in this study had higher ISS stage at diagnosis and worse ECOG performance status scores. Baseline labs showed inferior renal function and lower platelet and hemoglobin levels. Emotional and financial status was rated higher than younger patients, while physical functioning was worse. A trend towards decreased incidence of t(4;14) was appreciated by age.Table 1Clinical Characteristics≥ 75 years (n=92)< 75 years (n=533)PDemographicsMedian age in years8063Sex %NSMale6360Female3740Race %NSWhite8179Black1918Other03Heavy Chain %NSIgG8377IgA1723Light Chain %NSKappa6562Lambda3337Biclonal21Disease BurdenISS Stage %<0.001I1637II3236III5227Serum M-Protein g/dL2.962.8NSBone Marrow % Plasma Cells9.68.6NSCalcium mmol/L2.352.35NSCreatinine μmol/L114.991.10.003Hgb mmol/L6.16.60.046Platelets x109/L191.52160.001LDH μkat/L2.652.81NSHealth-Related Symptoms/Quality of Life MeasuresECOG (%)0.002023411524721483-4114Global Health Scale55.658.9NSPhysical Functioning Scale62.471.30.009Social Functioning Scale68.868.6NSRole Functioning Scale5860.6NSEmotional Functioning Scale80.271.90.003Cognitive Functioning Scale77.280.9NSFinancial Difficulties Scale14.423.80.01Fatigue Scale40.338.2NSPain Scale39.341.1NSMolecular Characteristics (% of Patients)Abnormal Cytogenetics4143NSdel 133129NSdel 171919NSt(11;14)14.319.7NSt(4;14)710.3NSSubset Analysis of t(4;14)>75 years65-75 years<65 yearsPt(4;14) (% of patients)57130.053Median presented unless specified DisclosuresVij:Takeda, Onyx: Research Funding; Celgene, Onyx, Takeda, Novartis, BMS, Sanofi, Janssen, Merck: Consultancy.