Blood cancers

Myeloma survival gains seen in all ages


Survival with myeloma has improved across all age groups with treatment advances over the last 30 years, Australian figures show.

The findings, published in Leukemia & Lymphoma, challenge international studies suggesting survival gains have only been seen in younger patients and not in the elderly. 

The retrospective study using Queensland cancer registry data from 1982 to 2014 showed there was a significant improvement in five-year relative survival from 30% during the era of chemotherapy only treatment (1982-1995), to 43% after the advent of ASCT (1996-2007), then 53% with novel agents (2008-2014). 

This significant improvement was seen in patients <60 years (42% with only chemotherapy to 70% with novel agents), 60-69 year olds (31% to 65%), 70-70 years olds (26% to 47%) and ≥80 year olds (13% to 23%).

Across all treatment eras, relative survival was similar between males and females.

The study also found relative survival increased across all treatment eras within subgroups on the basis of socioeconomic status. While patients classified as disadvantaged had an inferior relative survival compared to affluent patients, their five-year survival had improved significantly from 39% to 46% across the study period. 

Similarly, rural  patients had poorer survival compared to urban patients (overall 40% v 45%) but both groups’ survival had improved over treatment eras (27% to 49% v 31% to 55%).

The results of the overall survival (OS) analysis essentially mimicked those of the relative survival analysis –  an age-gradient with better OS for younger patients and a treatment-gradient with better OS with treatment advances over time.

The study said the introduction of ASCT would have contributed to improvements in younger patients with good performance status whereas the introduction of agents such as bortezomib, thalidomide and lenalidomide would have benefited all age groups. 

“Other important advances during this >30-year study period occurred in the management of renal failure, supportive care (e.g. anti-infective prophylaxis, granulocyte colony-stimulating factor, anti-nausea medications, intravenous immunoglobulin replacement), venous thromboembolism prophylaxis and the use of intravenous bisphosphonates (e.g. zoledronic acid) to treat hypercalcemia and treat or prevent osteolytic bone disease to avoid pathological fracture.”

They concluded all treating medical practitioners should be aware of the benefits of coordinated care in the tertiary setting for rural and/or disadvantaged SES patients to ensure equity of access to effective treatment. 

“Although myeloma is considered incurable, our data demonstrates access to effective treatment improves survival.”

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