Defining cure in multiple myeloma: A comparative study of outcomes of young individuals with myeloma and curable hematologic malignancies

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Abstract

Advances in therapy in recent years have led investigators to challenge the dogma that multiple myeloma (MM) is incurable. We assessed overall (OS) and progression-free survival (PFS) of young patients (≤ 50 years) with MM and compared outcomes with follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), and Hodgkin lymphoma (HL). All patients ≤ 50 years with newly diagnosed MM (n = 212), FL (n = 168), DLBCL (n = 195), and HL (n = 233) between 1 January 2005 and 31 December 2015 were included. Observed vs. expected survival was summarized by standardized mortality ratios (SMR). Compared to the background US population, excess mortality risk was seen at diagnosis in all four cancers, SMR 19.5 (15.2-24.5) in MM, 4.2 (2.3-7.2) in FL, 13.0 (9.2-18.4) in DLBCL, and 5.2 (2.6-9.3) in HL. We reasoned that cure would most likely occur in the first 3 years after diagnosis and be reflected by an overall survival probability similar to the background population. From the 36-month landmark, excess mortality risk was seen in MM (SMR 20.7 [14.7-28.3]) and FL (SMR 3.8 [1.5-7.8]), but not with DLBCL (SMR 3.1 [0.8-8.0]) or HL (SMR 0.9 [0.0-5.1]). MM patients have 20-fold excess mortality risk compared to the background population at diagnosis and at 3 years after diagnosis, suggesting that MM remains an incurable cancer.

Original languageEnglish (US)
Article number26
JournalBlood Cancer Journal
Volume8
Issue number3
DOIs
StatePublished - Mar 1 2018

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Hematologic Neoplasms
Multiple Myeloma
Outcome Assessment (Health Care)
Mortality
Follicular Lymphoma
Lymphoma, Large B-Cell, Diffuse
Hodgkin Disease
Population
Survival
Disease-Free Survival
Neoplasms
Research Personnel

ASJC Scopus subject areas

  • Hematology
  • Oncology

Cite this

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title = "Defining cure in multiple myeloma: A comparative study of outcomes of young individuals with myeloma and curable hematologic malignancies",
abstract = "Advances in therapy in recent years have led investigators to challenge the dogma that multiple myeloma (MM) is incurable. We assessed overall (OS) and progression-free survival (PFS) of young patients (≤ 50 years) with MM and compared outcomes with follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), and Hodgkin lymphoma (HL). All patients ≤ 50 years with newly diagnosed MM (n = 212), FL (n = 168), DLBCL (n = 195), and HL (n = 233) between 1 January 2005 and 31 December 2015 were included. Observed vs. expected survival was summarized by standardized mortality ratios (SMR). Compared to the background US population, excess mortality risk was seen at diagnosis in all four cancers, SMR 19.5 (15.2-24.5) in MM, 4.2 (2.3-7.2) in FL, 13.0 (9.2-18.4) in DLBCL, and 5.2 (2.6-9.3) in HL. We reasoned that cure would most likely occur in the first 3 years after diagnosis and be reflected by an overall survival probability similar to the background population. From the 36-month landmark, excess mortality risk was seen in MM (SMR 20.7 [14.7-28.3]) and FL (SMR 3.8 [1.5-7.8]), but not with DLBCL (SMR 3.1 [0.8-8.0]) or HL (SMR 0.9 [0.0-5.1]). MM patients have 20-fold excess mortality risk compared to the background population at diagnosis and at 3 years after diagnosis, suggesting that MM remains an incurable cancer.",
author = "Praful Ravi and Kumar, {Shaji K} and Cerhan, {James R} and Maurer, {Matthew J.} and Dingli, {David M} and Ansell, {Stephen Maxted} and Rajkumar, {S Vincent}",
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T2 - A comparative study of outcomes of young individuals with myeloma and curable hematologic malignancies

AU - Ravi, Praful

AU - Kumar, Shaji K

AU - Cerhan, James R

AU - Maurer, Matthew J.

AU - Dingli, David M

AU - Ansell, Stephen Maxted

AU - Rajkumar, S Vincent

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N2 - Advances in therapy in recent years have led investigators to challenge the dogma that multiple myeloma (MM) is incurable. We assessed overall (OS) and progression-free survival (PFS) of young patients (≤ 50 years) with MM and compared outcomes with follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), and Hodgkin lymphoma (HL). All patients ≤ 50 years with newly diagnosed MM (n = 212), FL (n = 168), DLBCL (n = 195), and HL (n = 233) between 1 January 2005 and 31 December 2015 were included. Observed vs. expected survival was summarized by standardized mortality ratios (SMR). Compared to the background US population, excess mortality risk was seen at diagnosis in all four cancers, SMR 19.5 (15.2-24.5) in MM, 4.2 (2.3-7.2) in FL, 13.0 (9.2-18.4) in DLBCL, and 5.2 (2.6-9.3) in HL. We reasoned that cure would most likely occur in the first 3 years after diagnosis and be reflected by an overall survival probability similar to the background population. From the 36-month landmark, excess mortality risk was seen in MM (SMR 20.7 [14.7-28.3]) and FL (SMR 3.8 [1.5-7.8]), but not with DLBCL (SMR 3.1 [0.8-8.0]) or HL (SMR 0.9 [0.0-5.1]). MM patients have 20-fold excess mortality risk compared to the background population at diagnosis and at 3 years after diagnosis, suggesting that MM remains an incurable cancer.

AB - Advances in therapy in recent years have led investigators to challenge the dogma that multiple myeloma (MM) is incurable. We assessed overall (OS) and progression-free survival (PFS) of young patients (≤ 50 years) with MM and compared outcomes with follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), and Hodgkin lymphoma (HL). All patients ≤ 50 years with newly diagnosed MM (n = 212), FL (n = 168), DLBCL (n = 195), and HL (n = 233) between 1 January 2005 and 31 December 2015 were included. Observed vs. expected survival was summarized by standardized mortality ratios (SMR). Compared to the background US population, excess mortality risk was seen at diagnosis in all four cancers, SMR 19.5 (15.2-24.5) in MM, 4.2 (2.3-7.2) in FL, 13.0 (9.2-18.4) in DLBCL, and 5.2 (2.6-9.3) in HL. We reasoned that cure would most likely occur in the first 3 years after diagnosis and be reflected by an overall survival probability similar to the background population. From the 36-month landmark, excess mortality risk was seen in MM (SMR 20.7 [14.7-28.3]) and FL (SMR 3.8 [1.5-7.8]), but not with DLBCL (SMR 3.1 [0.8-8.0]) or HL (SMR 0.9 [0.0-5.1]). MM patients have 20-fold excess mortality risk compared to the background population at diagnosis and at 3 years after diagnosis, suggesting that MM remains an incurable cancer.

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