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Improved long-term survival in multiple myeloma up to the age of 80 years

Leukemia volume 28, pages 1346–1348 (2014)Cite this article

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In the Western world, the annual age-adjusted incidence for multiple myeloma is 4.8 to 8 per 100 000.1 The median age at diagnosis is approximately 70 years and is only occasionally diagnosed in persons aged below 40 years.2 In recent years, several new therapeutic agents with novel mechanisms of action have been approved by the FDA for multiple myeloma such as lenalidomide, pomalidomide, bortezomib and carfilzomib.3 According to randomized clinical trials, survival has improved with these drugs. Importantly, randomized clinical trials are inherently subject to selection bias owing to strict inclusion and exclusion criteria, often with omission of elderly patients.2, 4, 5 Population-based studies are effective to estimate survival changes over time in a non-selected group of persons.6

In 2007, using population-based data from Sweden on 14 381 multiple myeloma patients, we were the first to show that multiple myeloma survival has improved in the general population,2 which was later confirmed by other studies.2, 7, 8, 9, 10 In fact, several population-based studies in multiple myeloma have consistently shown that the improvements in survival over the last years are restricted to the younger multiple myeloma patents (below the age of 65–70 years) and that elderly patients have not benefitted from the introduction of the new drugs. This, in turn, suggests that high-dose melphalan therapy followed by autologous stem cell transplantation has been the main driver for the observed improvement in survival in population-based multiple myeloma studies.2, 8 However, the use of modern drugs among older patients is a relatively new phenomenon, and, until date, no population-based study with sufficient follow-up has been conducted to formally assess survival patterns in older multiple myeloma patients in the era of modern drugs.

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Authors and Affiliations

  1. Division of Hematology, Department of Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden

    S Y Kristinsson

  2. University of Iceland and Department of Hematology, Faculty of Medicine, Landspitali National University Hospital, Reykjavik, Iceland

    S Y Kristinsson

  3. Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA

    W F Anderson

  4. Multiple Myeloma Section, Metabolism Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA

    O Landgren

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  1. S Y Kristinsson
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Correspondence to S Y Kristinsson.

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Kristinsson, S., Anderson, W. & Landgren, O. Improved long-term survival in multiple myeloma up to the age of 80 years. Leukemia 28, 1346–1348 (2014). https://doi.org/10.1038/leu.2014.23

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