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An Organotypic High Throughput System for Characterization of Drug Sensitivity of Primary Multiple Myeloma Cells
Published on: July 15, 2015
Disparities in treatment patterns and outcomes among younger and older adults with newly diagnosed multiple myeloma:
Hira S Mian1, Hsien Seow1, Tanya M Wildes2
1Juravinski Cancer Center, Department of Oncology, McMaster University, Hamilton, ON, Canada.
Introduction:
Multiple myeloma, a cancer of older adults, has seen significant improvement in therapeutic options over the past two decades. Uncovering disparities in treatment patterns and outcomes is imperative in order to ensure older adults, who are underrepresented in clinical trials, are benefitting from these advances.
Methods:
Adults with newly diagnosed multiple myeloma (NDMM) were identified using linked provincial administrative databases between 2007 and 2017 in Ontario, Canada. Trends in rate of no treatment, novel drug and autologous stem cell transplant (ASCT) usage was evaluated within one year following diagnosis along with the associated early mortality (<12 months) for the aforementioned cohorts among younger (≤65 years) and older adults (>65 years) with NDMM.
Results:
A total of 8841 adults with NDMM were identified. Rates of no treatment decreased in both age groups during the study period; however still remain considerably high among older patients (from 34.9% in 2007 to 27.4% in 2017) with high associated early mortality in the older untreated group (54.1% 1 yr mortality over study period). Despite increased usage of novel drugs in both age groups, early mortality decreased among younger patients utilizing novel drugs (16.1% to 5.6%) but remained high and stagnant in older patients using novel drugs (18.2% 1 yr mortality over study period). ASCT utilization increased in both age groups during the study period with decreasing early mortality among older patients undergoing ASCT (from 26.3% in 2007 to 1.1% in 2017).
Conclusion:
While several improvements have been made, rates of no treatment and early mortality among patients not treated and those started on novel drugs remains a concern in older adults with NDMM.
Insights
Older adults with newly diagnosed multiple myeloma (NDMM) still face high rates of no treatment and early mortality, particularly when not receiving novel drugs. While autologous stem cell transplant (ASCT) improved outcomes for older patients, disparities persist.
Area of Science:
- Hematology
- Oncology
- Geriatrics
Background:
- Multiple myeloma treatment has advanced significantly over the last two decades.
- Older adults are underrepresented in clinical trials, necessitating research into treatment disparities.
Purpose of the Study:
- To investigate treatment patterns and early mortality in younger versus older adults with newly diagnosed multiple myeloma (NDMM).
- To identify disparities in the utilization of novel drugs and autologous stem cell transplant (ASCT) and their impact on outcomes in older adults.
Main Methods:
- A cohort of 8841 adults with NDMM was identified using linked provincial administrative databases in Ontario, Canada (2007-2017).
- Trends in no treatment, novel drug, and ASCT usage within one year of diagnosis were analyzed.
- Early mortality (<12 months) was compared between younger (≤65 years) and older (>65 years) adults with NDMM.
Main Results:
- Rates of no treatment decreased but remained high in older adults (27.4% in 2017), associated with 54.1% 1-year mortality.
- Novel drug usage increased, improving early mortality in younger patients (5.6%) but not older patients (18.2%).
- ASCT utilization rose, significantly decreasing early mortality in older patients (from 26.3% to 1.1%).
Conclusions:
- Despite therapeutic advances, significant disparities in treatment and high early mortality persist for older adults with NDMM, especially those not treated or treated with novel drugs alone.
- Autologous stem cell transplant (ASCT) has shown substantial benefit in reducing early mortality for older adults with NDMM.
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