Understanding mortality in multiple myeloma: Findings of a European retrospective chart review

Abstract

Objectives: This study aimed to provide real-world data on the characteristics and treatment of patients with multiple myeloma (MM) at the time of death.

Methods: The study was a retrospective patient chart review across France, Germany, Italy, Spain and the UK during 2016, and included patients who had died in the 3 months before the index date.

Results: Data from 786 patients were reviewed. At the time of death, 37% of patients were receiving active treatment, 12% were in a treatment-free interval and 51% were receiving only supportive care. Death before and during active first-line treatment was not uncommon (6% and 24% of patients, respectively) but these deaths were often not solely due to disease progression; factors such as renal failure and infection frequently played a role (in 30% and 20% of patients at first-line, respectively). Most deaths at later lines were due to progressive disease. Cox model results suggested that early deaths were associated with advanced disease stage, high-risk cytogenetics and poor response and relapse profiles.

Conclusions: These real-world data could be used to help develop strategies for improving survival in patients with MM and to support management tailored to the stage of disease.

Keywords: Europe; death; mortality; multiple myeloma; risk; survival.

Conflict of interest statement

M Mohty has received honoraria from Amgen, BMS, Celgene, Janssen, Takeda, Novartis, Sanofi and research funding from Celgene, Janssen, Sanofi. M Cavo has received honoraria from Amgen, Bristol‐Myers Squibb, Celgene, Janssen and Takeda; L Fink is an employee of Kantar Health, which received funding from Amgen to conduct this research; S Gonzalez‐McQuire is an Amgen employee and holds Amgen stock; H Leleu has received honoraria from Amgen; M Mateos has received honoraria from Janssen, Celgene, Amgen, Takeda derived from lectures and participation in advisory boards; MS Raab has received research support from Amgen, Novartis and honoraria from Amgen, Novartis, Celgene, Janssen and BMS; P Schoen is an Amgen employee and holds Amgen stock; K Yong has received honoraria from Celgene, Amgen, Takeda, Sanofi and Janssen, research funding from Janssen, Amgen and Celgene and was a consultant for Autolus.

© 2019 The Authors European Journal of Haematology Published by John Wiley & Sons Ltd.

Figures

Figure 1

Age at time of death, by treatment line. Categorisation by treatment line includes patients who died during or following each line, before moving on to the subsequent line. Total patient number is reported here as 789, rather than 786, owing to weighting of the data. L, treatment line

Figure 2

A, Patient flow through the treatment pathway. Categorisation by treatment line includes patients who died during or following each line, before moving on to the subsequent line. Total patient number is reported here as 789, rather than 786, owing to weighting of the data. L, treatment line. B, Overall survival according to treatment line at time of death. Black line and data labels show the median overall survival in months. L, treatment line

Figure 3

Causes of deatha (A) overall and (B) by line, and (C) overall stratified by response status at time of death. Total patient number is reported here as 789, rather than 786, owing to weighting of the data. aMultiple factors may be captured as cause of death. L, treatment line

Figure 4

Factors associated with overall survival after MM diagnosis. Results of an exploratory multivariate Cox model regression analysis of overall survival from MM diagnosis using data from 338 patients. The analysis included variables at baseline and outcomes at 1L treatment for patients who had initiated at least one treatment line and progressed after 1L. Patients with missing or unknown values for the variables tested were excluded from the analysis. High cytogenetic risk was defined as having t(4;14), t(14;16) or del(17p). Low cytogenetic risk was defined as being negative for all three cytogenetic abnormalities. CI, confidence interval; ECOG, Eastern Cooperative Oncology Group; HR, hazard ratio; ISS, International Staging System; L, treatment line; MM, multiple myeloma; PR, partial response; SCT, stem cell transplantation; TTP, time to progression; VGPR, very good partial response