Abstract
Introduction
Multiple myeloma, a cancer of older adults, has seen significant improvement in therapeutic
options over the past two decades. Uncovering disparities in treatment patterns and
outcomes is imperative in order to ensure older adults, who are underrepresented in
clinical trials, are benefitting from these advances.
Methods
Adults with newly diagnosed multiple myeloma (NDMM) were identified using linked provincial
administrative databases between 2007 and 2017 in Ontario, Canada. Trends in rate
of no treatment, novel drug and autologous stem cell transplant (ASCT) usage was evaluated
within one year following diagnosis along with the associated early mortality (<12 months)
for the aforementioned cohorts among younger (≤65 years) and older adults (>65 years)
with NDMM.
Results
A total of 8841 adults with NDMM were identified. Rates of no treatment decreased
in both age groups during the study period; however still remain considerably high
among older patients (from 34.9% in 2007 to 27.4% in 2017) with high associated early
mortality in the older untreated group (54.1% 1 yr mortality over study period). Despite
increased usage of novel drugs in both age groups, early mortality decreased among
younger patients utilizing novel drugs (16.1% to 5.6%) but remained high and stagnant
in older patients using novel drugs (18.2% 1 yr mortality over study period). ASCT
utilization increased in both age groups during the study period with decreasing early
mortality among older patients undergoing ASCT (from 26.3% in 2007 to 1.1% in 2017).
Conclusion
While several improvements have been made, rates of no treatment and early mortality
among patients not treated and those started on novel drugs remains a concern in older
adults with NDMM.
Keywords
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Article info
Publication history
Published online: October 24, 2020
Accepted:
October 16,
2020
Received in revised form:
October 13,
2020
Received:
July 20,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
