P-124: Trends in survival and causes of death in multiple myeloma: a single-institution experience

Introduction: During the last few decades, treatment options for multiple myeloma (MM) have markedly progressed, and the overall survival (OS) has significantly improved. However, MM remains incurable, and patients are at risk of death from MM progression as well as complications and comorbidities. With the recent trends for prolonged survival and long-term treatment with novel agents, the cause of death may have changed over time. Understanding the recent trends in OS and causes of death is crucial for evaluating the efficacy of therapeutic strategies and patient prognosis in the era of novel agents. Thus, we investigated the trends in OS and causes of death in MM patients in a real-world setting.

Methods: We examined the registry data for patients diagnosed with MM in our hospital between 2006 and 2022, and compared the incidence and causes of death between the periods of 2006−2014 and 2015−2022.

Results: A total of 291 patients with MM were registered during the study period. The median age of the total patients was 74 years (range, 41−93 years), and 74 patients (25%) were aged ≥80 years. Regarding the two periods, 122 patients were registered in 2006−2014 (Period A), and 169 patients were registered in 2015−2022 (Period B). The population of patients aged ≥80 years was higher in Period B than in Period A (29% vs. 21%, p=0.104). There were no differences in other baseline characteristics, including sex, Ig subtype, performance status, and International Staging System stage, between the two groups. The median follow-up period was 23.5 months (range, 0.5−177.7 months). The median OS was 28.8 for Period A and not reached for Period B, with 107 and 50 deaths in Periods A and B, respectively. The OS at 2 years was significantly better in Period B than Period A (all patients: 74% vs. 52%, p< 0.001; younger group aged < 80 years: 79% vs. 57%, p< 0.001; older group aged ≥80 years: 58% vs. 31%, p=0.008). The main cause of death in both periods was disease progression, followed by infection, cardiovascular disease, renal failure, and second malignancy. The cumulative incidence of death from MM progression was higher in Period A in Period B (26% vs. 13%, p=0.011). The cumulative incidence of death from causes other than MM was also higher in Period A than in Period B (22% vs. 3.4%, p< 0.001). Similar trends were observed in patients aged ≥80 years.



Conclusions: While MM-specific mortality has decreased over time, MM progression remains a threat to survival in MM patients. However, our findings show that not only disease control with novel agents but also improvements in complication control have contributed to the improved prognosis of MM patients. Clinicians should remain aware of the risks associated with MM treatments and underlying complications. Moreover, elderly patients exhibited similar trends in OS and causes of death, suggesting that they have also benefited from recent treatment advances with novel agents.