The impact of age and comorbidities on practice patterns and outcomes in patients with relapsed/refractory multiple myeloma in the era of novel therapies

Objectives: One-third of patients with multiple myeloma (MM) are diagnosed at age I. 75 years. Older patients have increased incidence of cardiovascular disease (CVD) and renal insufficiency (RI), hallmark complications of MM. We examined cumulative incidence of CVD and RI in relapsed/refractory MM (RRMM) and outcomes by age and RI/CVD. Materials and Methods: Retrospective cohort study using a large US electronic medical records database of adult patients with RRMM initiating first- and second-line therapy (2LT) between 1/2008-06/2015. RI and CVD comorbidities were based on diagnosis codes and/or lab values. Results: Among 628 patients, 37.1% were >= 1.75 years. Cumulative incidence of CVD and/or RI increased from 47.7% at MM diagnosis to 67.8% at first relapse. Age >= 75 years had a trend toward higher risk of relapse post 2LT, proxied by time to next treatment (TTNT), (adjusted HR: 128; 95% CI: 1.00, 1.65; P = 0.05). TINT was significantly higher with comorbid CVD + RI (adjusted HR: 1.50; 95% CI: 1.11, 2.02; P < 0.01). Age >= 75 years, RI, CVD, and CVD + RI were associated with increased mortality risk from 2LT initiation; adjusted FIR: 1.66 (95% Cl: 1.19, 233; P < 0.01), 1.51 (95% CI: 1.01, 226; P = 0.04), 1.75 (95% CI: 1.03, 2.96; P = 0.04), and 1.95 (95% CI: 1.29, 2.93; P < 0.01), respectively. Conclusion: Despite treatment with novel agents for RRMM in 86% of patients, an outcome gap persists for older patients and those with RI and/or CID. Personalized treatment approaches that account for age and comorbidities, and further evaluation of innovative regimens and dosing schedules, are needed to improve outcomes for these patients. (C) 2017 The Authors. Published by Elsevier Ltd. This is an open access artide under the CC BY-NC-ND license.