Improved survival in multiple myeloma and the impact of novel therapies

Abstract

Treatments for myeloma have expanded in the last decade, but it is not clear if the introduction of novel therapies and the increased use of high-dose therapy have translated into better outcome for patients with myeloma. We examined the outcome of 2 groups of patients seen at a single institution, one from time of diagnosis and the other from the time of relapse, to examine the survival trends over time. Among 387 patients relapsing after stem-cell transplantation, a clear improvement in overall survival from the time of relapse was seen, with those relapsing after 2000 having a median overall survival of 23.9 versus 11.8 months (P < .001) for those who relapsed prior to this date. This improvement was independent of other prognostic factors. Patients treated with one or more of the newer drugs (thalidomide, lenalidomide, bortezomib) had longer survival from relapse (30.9 vs 14.8 months; P < .001). In a larger group of 2981 patients with newly diagnosed myeloma, those diagnosed in the last decade had a 50% improvement in overall survival (44.8 vs 29.9 months; P < .001). In this study, we demonstrate improved outcome of patients with myeloma in recent years, both in the relapsed setting as well as at diagnosis.

Figures

Figure 1

Overall survival from time of relapse after ASCT. (A) The Kaplan-Meier curves for overall survival from the time of posttransplantation relapse. The patients are grouped into 2-year intervals based on the date of relapse. (B) The Kaplan-Meier curves for the overall survival from the time of posttransplantation relapse grouped by whether they were treated subsequently with one or more of the newer drugs (thalidomide, bortezomib, or lenalidomide). Survival curves were compared using log-rank test.

Figure 2

Overall survival from diagnosis of multiple myelomas. (A) The Kaplan-Meier curves for overall survival from diagnosis. The groups were divided based on the date of diagnosis: within last decade (after December 31, 1996) versus on or before December 31, 1996. (B) The Kaplan-Meier curves for overall survival from the time of diagnosis grouped into 6-year intervals based on the date of diagnosis.