Impact of age and comorbodity as prognostic factors on overall survival in patients with multiple myeloma

Abstract

Background: Multiple myeloma is a heterogeneous disease with variable disease course, a wide range of clinical presentation and many subtypes, variable response to therapy and survival outcome that ranges from less than one year in patients with aggressive disease to more than ten years in patients with indolent disease presentation. It is very important to clearly define the risk profile of each patient during establishing the diagnosis, and to predict the eventual type of therapeutic approach, its depth, quality and length. The age >75 and presence of comorbidities at the start of therapy are risk factors which impact on the quality of life, therapy response and overall survival (OS) in patients with multiple myeloma (MM). Aim: The aim of this study was to assess the influence of the two most important risk factors in myeloma patients, ageism and comorbidities, that complicate the management of MM and at the same time OS. Patients and methods: We retrospectively analyzed a total of 296 myeloma patients (150 male and 146 female) with average age of 62 ±10.3 years. The most affected age group (58.1%) comprised patients at the age ranging between 60 and 88 years, diagnosed at the University Clinic of Hematology, Ss Cyril and Methodius University, Skopje, Macedonia in the period 2005-2015. The follow-up period was 24 months. We evaluated some parameters that could influence OS: age and comorbidity that could influence the overall clinical condition of the patient during his therapy and his eventual future disease behavior. OS was estimated on monthly basis including the period from the date of diagnosis to the time of death / time of last visit. Results: In the study group 26% of patients ≥ 65 years have survived more than 60 months, and 40% younger than 65 years have survived more than 60 months. Survival time in group ≥65 years is 18.3 months, and in group <65 years is 43.4 months. It is evident that age had a significant effect on OS in myeloma patients, and 49% of patients with no registered comorbodity preceding the diagnostic procedures had survived more than 60 months, but only 16% of patients with registered comorbidity survived more than 60 months. Survival time in patients with registered comorbodity preceding the diagnostic procedures was 59.3 months and survival time in patients with registered comorbodity before the diagnostic procedures is 10.7 months. Conclusions: The age-related changes in physiology combined with comorbid conditions, disability or frailty have important implications in the treatment of myeloma patients. Based on these risk factors our recommendation is tailored treatment for each MM patient. Key words: multiple myeloma, prognostic factors, overall survival