Early mortality in elderly patients undergoing treatment for multiple myeloma in real-world practice

Xia, Jun; Wang, Lingling; Zhou, Xin; Wang, Jing; Wang, Huan; Guo, Hongwei

doi:10.1177/0300060518757640

Cited by 7 publications

(13 citation statements)

References 22 publications

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“…In the United-Kingdom MRC Trial, 10% of patients died within 60 days of diagnosis, with 45% of deaths due to infection, many in elderly patients [ 25 ]. Infection is the leading cause of early mortality in elderly MM patients, who have age-related immune dysfunction and comorbidities [ 26 ].…”

Section: Role Of Infection In Outcome Of MMmentioning

confidence: 99%

Inflammation and infection in plasma cell disorders: how pathogens shape the fate of patients

et al. 2022

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The role of infection and chronic inflammation in plasma cell disorders (PCD) has been well-described. Despite not being a diagnostic criterion, infection is a common complication of most PCD and represents a significant cause of morbidity and mortality in this population. As immune-based therapeutic agents are being increasingly used in multiple myeloma, it is important to recognize their impact on the epidemiology of infections and to identify preventive measures to improve outcomes. This review outlines the multiple factors attributed to the high infectious risk in PCD (e.g. the underlying disease status, patient age and comorbidities, and myeloma-directed treatment), with the aim of highlighting future prophylactic and preventive strategies that could be implemented in the clinic. Beyond this, infection and pathogens as an entity are believed to also influence disease biology from initiation to response to treatment and progression through a complex interplay involving pathogen exposure, chronic inflammation, and immune response. This review will outline both the direct and indirect role played by oncogenic pathogens in PCD, highlight the requirement for large-scale studies to decipher the precise implication of the microbiome and direct pathogens in the natural history of myeloma and its precursor disease states, and understand how, in turn, pathogens shape plasma cell biology.

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Section: Role Of Infection In Outcome Of MMmentioning

confidence: 99%

Inflammation and infection in plasma cell disorders: how pathogens shape the fate of patients

et al. 2022

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“…This result indicated that neutropenia can be classi ed as one of the causes of infection. Additionally, there were many other risk factors for early infection, such as hypoalbuminemia, the complications of diabetes, and the late staging of ISS in our patients with MM [25]. Further analysis reported that the common types of early infection included pneumonia, colitis, and fever of unknown origin.…”

Section: Discussionmentioning

confidence: 77%

Long-acting granulocyte colony-stimulating factor in primary prophylaxis of early infection in patients with newly diagnosed multiple myeloma

Ding¹,

Ding²,

Gu³

et al. 2021

Preprint

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Purpose This study sought to compare the efficacy of prophylactic long-acting and standard granulocyte colony-stimulating factor (G-CSF) on febrile neutropenia, early infections, and treatment delay in patients with newly diagnosed multiple myeloma receiving the therapeutic regimen of bortezomib, lenalidomide, and dexamethasone (BLD). Methods A prospective study with 68 consecutive patients with multiple myeloma was conducted in three regional hospitals. Participants were randomly treated with the BLD regimen in combination with prophylactic long-acting G-CSF (treatment group) or standard G-CSF (control group). The primary endpoints were the incidence rates of febrile neutropenia, early infection, and treatment delays. The secondary endpoint was clinical outcomes. Results Thirty-three patients were assigned to the treatment group and thirty-five patients were assigned to the control group. The incidence of febrile neutropenia was 6.1% and 17.1% in the treatment and control groups, respectively (p = 0.297). However, the rates of early infection and treatment delay were markedly lower in the treatment group than in the control group (6.1% vs. 25.7% and 9.1% vs. 31.4%; p < 0.05). Notably, all early infections occurred during the first four cycles of BLD therapy, and the most common type of infection was pneumonia. No significant difference in clinical efficacy was found between the two groups. All participants achieved at least partial remission. Conclusions Prophylactic administration of domestic long-acting G-CSF markedly reduced the rates of early infection and treatment delay as compared with standard G-CSF in patients newly diagnosed with multiple myeloma. Notably, all early infections occurred during the first four cycles of BLD therapy. As such, it seems appropriate to administer long-acting G-CSF with the aim of primary prophylaxis of early infection, particularly within the first four courses of chemotherapy in the setting of newly diagnosed multiple myeloma.

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“…Older age was found to be associated with lower odds of arrhythmia-related mortality possibly because these patients are dying from other causes. A study conducted among elderly patients with MM observed the most common causes of death in this population to be infection, heart failure, and renal failure 19. However, arrhythmias were not examined in this study.…”

Section: Discussionmentioning

confidence: 82%

Burden of arrhythmias and predictors of mortality among multiple myeloma patients with arrhythmias

Balogun

Jackson

Oyenuga

et al. 2022

Journal of Investigative Medicine

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Arrhythmias are a major cardiac complication reported among patients with multiple myeloma (MM), but these have not been further characterized in this population. We explored the prevalence of arrhythmias and examined the predictors of mortality among patients with MM with arrhythmias. The National Inpatient Sample data collected between 2016 and 2018 were used to conduct retrospective analyses. Multivariable logistic regression analyses were done to examine the predictors of mortality among patients with MM with arrhythmias. 16.9% of patients with MM reported a diagnosis of any arrhythmias and 70.7% of these were atrial fibrillation. Patients aged 70 years and above had 21% lower odds (adjusted OR (AOR): 0.79; 95% CI: 0.68 to 0.92) of inpatient mortality relative to younger patients. Those in the non-Hispanic black, Hispanic, and non-Hispanic other category were 1.38 (95% CI: 1.16 to 1.64), 1.53 (95% CI: 1.19 to 1.97), and 1.69 (95% CI: 1.29 to 2.21) times more likely to die during hospitalization compared with their counterparts who were non-Hispanic whites. Relative to patients with MM who were on Medicare, those on private (AOR: 1.28; 95% CI: 1.06 to 1.54) and other insurance types (AOR: 1.78; 95% CI: 1.23 to 2.58) had higher odds of mortality. Other predictors of inpatient mortality were elective admission (AOR: 0.67; 95% CI: 0.52 to 0.85) and Charlson comorbidity indices between 5–7 (AOR: 1.23; 95% CI: 1.07 to 1.41) and ≥8 (AOR: 1.45; 95% CI: 1.21 to 1.73) compared with comorbidity indices between 0 and 4. Our study adds to the body of knowledge on the need for proper diagnosis and management of cardiac arrhythmias in patients with MM. Research is needed to further assess the time of arrhythmia diagnosis and its impact on health outcomes among patients with MM.

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Early mortality in elderly patients undergoing treatment for multiple myeloma in real-world practice

Cited by 7 publications

References 22 publications

Inflammation and infection in plasma cell disorders: how pathogens shape the fate of patients

Inflammation and infection in plasma cell disorders: how pathogens shape the fate of patients

Long-acting granulocyte colony-stimulating factor in primary prophylaxis of early infection in patients with newly diagnosed multiple myeloma

Burden of arrhythmias and predictors of mortality among multiple myeloma patients with arrhythmias

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