Scientific publications

Early myeloma-related death in elderly patients: development of a clinical prognostic score and evaluation of response sustainability role

Feb 23, 2018 | Magazine: Leukemia

Rodríguez-Otero P (1), Mateos MV (2), Martínez-López J (3), Martín-Calvo N (4), Hernández MT (5), Ocio EM (2), Rosiñol L (6), Martínez R (7), Teruel AI (8), Gutiérrez NC (2), Bargay J (9), Bengoechea E (10), González Y (11), de Oteyza JP (12), Gironella M (13), Encinas C (14), Martín J (15), Cabrera C (16), Palomera L (17), de Arriba F (18), Cedena MT (3), Paiva B (1), Puig N (2), Oriol A (19), Bladé J (6), Lahuerta JJ (4), San Miguel JF (20).

(1) Clínica Universidad de Navarra, CIMA, IDISNA, CIBERONC, Pamplona, Spain.
(2) Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain.
(3) Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre, CIBERONC, Madrid, Spain.
(4) Preventive Medicine and Public Health Department, University of Navarra, Pamplona, Spain.
(5) Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
(6) Hospital Clinic I Provincial, Institu d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
(7) Hospital Clínico San Carlos, Madrid, Spain.
(8) Hospital Clínico de Valencia, Valencia, Spain.
(9) Hospital Son Llatzer, Palma de Mallorca, Spain.
(10) Hospital de Donostia, San Sebastian, Spain.
(11) Institut d'Oncologia Dr. Josep Trueta, Girona, Spain.
(12) Hospital de Madrid Sanchinarro, Universidad CEU San Pablo, Madrid, Spain.
(13) Hospital Vall d'Hebron, Barcelona, Spain.
(14) Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
(15) Hospital General Virgen del Rocío, Sevilla, Spain.
(16) Hospital San Pedro de Alcántara, Cáceres, Spain.
(17) Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
(18) Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain.
(19) Insitut Català d'Oncologia, Institut Josep Carreras, Hospital German Trias i Pujol, Badalona, Barcelona, Spain.
(20) Clínica Universidad de Navarra, CIMA, IDISNA, CIBERONC, Pamplona, Spain.


Although survival of elderly myeloma patients has significantly improved there is still a subset of patients who, despite being fit and achieving optimal responses, will die within 2 years of diagnosis due to myeloma progression.

The objective of this study was to define a scoring prognostic index to identify this group of patients. We have evaluated the outcome of 490 newly diagnosed elderly myeloma patients included in two Spanish trials (GEM2005-GEM2010). Sixty-eight patients (13.8%) died within 2 years of diagnosis (early deaths) due to myeloma progression.

Our study shows that the use of simple scoring model based on 4 widely available markers (elevated LDH, ISS 3, high risk CA or >75 years) can contribute to identify up-front these patients. Moreover, unsustained response (<6 months duration) emerged as one important predictor of early myeloma-related mortality associated with a significant increase in the risk of death related to myeloma progression.

The identification of these patients at high risk of early death is relevant for innovative trials aiming to maintain the depth of first response, since many of them will not receive subsequent lines of therapy.

CITATION  Leukemia. 2018 Feb 23. doi: 10.1038/s41375-018-0072-6.

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