Assessment of Vulnerability Measures and Their Effect on Survival in a Real-Life Population of Multiple Myeloma Patients Registered at Marche Region Multiple Myeloma Registry

Multiple myeloma (MM) therapy should be tailored according to patient characteristics although we do not know which ones to use. By studying the characteristics of 266 real-life patients, we found performance status (PS) and Charlson Comorbidity Index (CCI) as factors affecting survival of MM patients regardless of their disease characteristics. This study might help to select patients for tailoring therapy in clinical practice. Background: Multiple myeloma is a typical disease of the elderly but how many and which patients can be considered 'vulnerable' and how this may affect patient outcome remain unsolved issues. Patients and Methods: Data from 266 symptomatic MM patients registered at Marche MM registry from 2007 to 2010 were evaluated retrospectively. Vulnerability was defined as age > 75 years, PS (World Health Organization) >= 2, renal insufficiency (RI), bone fracture, cytopenias, and CCI score >= 1. Kaplan-Meier method and Cox regression were used to assess survival and associated factors. A vulnerability score (VS) incorporating significant vulnerability features was pursued to predict survival. Results: Thirty-eight percent of patients were older than 75 years, 39% had PS = 2-4, 35% had at least 2 cytopenias, 40% had bone fracture, 14% RI, and 51% had CCI score >= 1. Cox regression selected international staging system (ISS) = III (hazard ratio [HR] = 1.6; P =.033), PS = 2-4 (HR = 2.5; P =.007), and CCI = 1-3 (HR = 2.1; P =.028) as factors associated with a worse overall survival. A VS including PS and CCI predicted median survival of 27 months in the 63 patients having a VS = 2 (both PS = 2-4 and CCI = 1-3) versus not reached (NR) in the 203 patients with VS = 0-1 (HR = 4.0; P <.0001). In younger patients multivariate analysis selected ISS = III (HR = 5.2; P =.006) and VS = 2 (HR = 5.5; P =.024) as factors associated with shorter survival whereas only VS = 2 (HR = 3.5; P =.002) affected worse survival in elderly. Conclusion: Such VS proved to be a powerful prognostic factor for survival of MM patients and it might be useful to identify true vulnerable patients regardless of age. Clinical Lymphoma, Myeloma & Leukemia, Vol. 12, No. 6, 423-32 (C) 2012 Elsevier Inc. All rights reserved.