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 withχ2; 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 1.

Clinical Characteristics

≥ 75 years (n=92)< 75 years (n=533)P
Demographics 
Median age in years  80 63   
Sex %    NS  
Male  63 60   
Female 37 40   
Race %   NS  
White 81 79   
Black 19 18   
Other 0 3   
Heavy Chain %    NS  
IgG 83 77   
IgA 17 23   
Light Chain %   NS  
Kappa 65 62   
Lambda 33 37   
Biclonal 2 1   
Disease Burden 
ISS Stage %   <0.001  
I 16 37   
II 32 36   
III 52 27   
Serum M-Protein g/dL 2.96 2.8 NS  
Bone Marrow % Plasma Cells 9.6 8.6 NS  
Calcium mmol/L 2.35 2.35 NS  
Creatinine μmol/L 114.9 91.1 0.003  
Hgb mmol/L 6.1 6.6 0.046  
Platelets x109/L 191.5 216 0.001  
LDH μkat/L 2.65 2.81 NS  
Health-Related Symptoms/Quality of Life Measures 
ECOG (%)    0.002  
0 23 41   
1 52 47   
2 14 8   
3-4 11 4   
Global Health Scale 55.6 58.9 NS  
Physical Functioning Scale  62.4 71.3 0.009  
Social Functioning Scale 68.8 68.6 NS  
Role Functioning Scale 58 60.6 NS  
Emotional Functioning Scale  80.2 71.9 0.003  
Cognitive Functioning Scale 77.2 80.9 NS  
Financial Difficulties Scale 14.4 23.8 0.01  
Fatigue Scale 40.3 38.2 NS  
Pain Scale 39.3 41.1 NS  
Molecular Characteristics (% of Patients) 
Abnormal Cytogenetics 41 43 NS  
del 13  31 29 NS  
del 17  19 19 NS  
t(11;14) 14.3 19.7 NS  
t(4;14)  7 10.3 NS  
Subset Analysis of t(4;14) >75 years 65-75 years <65 years P 
t(4;14) (% of patients) 5 7 13 0.053 
≥ 75 years (n=92)< 75 years (n=533)P
Demographics 
Median age in years  80 63   
Sex %    NS  
Male  63 60   
Female 37 40   
Race %   NS  
White 81 79   
Black 19 18   
Other 0 3   
Heavy Chain %    NS  
IgG 83 77   
IgA 17 23   
Light Chain %   NS  
Kappa 65 62   
Lambda 33 37   
Biclonal 2 1   
Disease Burden 
ISS Stage %   <0.001  
I 16 37   
II 32 36   
III 52 27   
Serum M-Protein g/dL 2.96 2.8 NS  
Bone Marrow % Plasma Cells 9.6 8.6 NS  
Calcium mmol/L 2.35 2.35 NS  
Creatinine μmol/L 114.9 91.1 0.003  
Hgb mmol/L 6.1 6.6 0.046  
Platelets x109/L 191.5 216 0.001  
LDH μkat/L 2.65 2.81 NS  
Health-Related Symptoms/Quality of Life Measures 
ECOG (%)    0.002  
0 23 41   
1 52 47   
2 14 8   
3-4 11 4   
Global Health Scale 55.6 58.9 NS  
Physical Functioning Scale  62.4 71.3 0.009  
Social Functioning Scale 68.8 68.6 NS  
Role Functioning Scale 58 60.6 NS  
Emotional Functioning Scale  80.2 71.9 0.003  
Cognitive Functioning Scale 77.2 80.9 NS  
Financial Difficulties Scale 14.4 23.8 0.01  
Fatigue Scale 40.3 38.2 NS  
Pain Scale 39.3 41.1 NS  
Molecular Characteristics (% of Patients) 
Abnormal Cytogenetics 41 43 NS  
del 13  31 29 NS  
del 17  19 19 NS  
t(11;14) 14.3 19.7 NS  
t(4;14)  7 10.3 NS  
Subset Analysis of t(4;14) >75 years 65-75 years <65 years P 
t(4;14) (% of patients) 5 7 13 0.053 

Median presented unless specified

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Disclosures

Vij:Takeda, Onyx: Research Funding; Celgene, Onyx, Takeda, Novartis, BMS, Sanofi, Janssen, Merck: Consultancy.

Topics:
multiple myeloma, creatinine, electrocorticogram, hemoglobin, antigens, cd98 light chains, calcium, cancer, cognitive ability, fatigue, hemoglobin measurement

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2015 by The American Society of Hematology
2015
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