IMPACT OF ERYTHROPOIESIS STIMULATING AGENTS ON OVERALL SURVIVAL OF PATIENTS WITH MULTIPLE MYELOMA
(Abstract release date: 05/19/16)
EHA Library. Ortiz Zuluaga S. 06/09/16; 134869; PB1969
Mr. Sebastián Ortiz Zuluaga
Contributions
Contributions
Abstract
Abstract: PB1969
Type: Publication Only
Background
Treatment with erythropoiesis stimulating agents (ESA) in oncologic patients remains controversial. Since 2007, the FDA has included the addition of a black box label warning and the implementation of a risk management program for ESA prescription. Regarding treatment with ESA in patients with multiple myeloma (MM), there are only three studies with discordant results.
Aims
The purpose of our study is to explore the impact of ESA on overall survival in a cohort of MM patients treated in our center.
Methods
Between 2002 and 2015, 212 patients were diagnosed of MM in our center. We excluded 55 patients: 23 patients with diagnosis of smoldering myeloma and 32 patients candidates for palliative care because of age and comorbidities. We collected demographic information, clinical and laboratory data, staging according International Score System (ISS), regimens of treatment, overall survival (OS) as well as information on erythropoietin use for all patients.
Results
One hundred and fifty five patients were included: 63 received recombinant human erythropoietin (rhEPO) at least 1 month. The median total dose was 440000 international units (IU) (range 40000 – 10920000). Patient’s characteristics according EPO therapy are presented in table. Patients treated with rhEPO showed more advanced stages, higher creatinine levels and required hemodialysis more frequently. Nevertheless autologous stem cell transplantation was performed more frequently in non-EPO patients. There was no difference in first line therapy between rhEPO and non-EPO patients. The median OS in all patients was 31 months (CI95% 22.67-39.33) and we did not observe differences between EPO and non-EPO groups (35 vs. 31 months, Log Rank p=0.96). However, when looking at the influence of total EPO doses on outcome, we observed differences in OS between patients who received doses of EPO > 400000 IU, vs. patients with lower doses or untreated (50 vs. 23 months, Log Rank p=0.047). Multivariate analysis (Cox Regression) showed, age, albumin, Beta 2 microglobulin and rhEPO doses as independent prognostic factors for OS.
*UMW: U-Mann-Whitney, **Fisher test, ***Chi-square test
Conclusion
The use of rhEPO does not have a negative effect in MM patients. Our study suggests that treatment with high doses of rhEPO could have a positive impact to improved OS. However, prospective randomized studies to confirm these data are required.
Session topic: E-poster
Keyword(s): Erythropoietin, Multiple myeloma
Type: Publication Only
Background
Treatment with erythropoiesis stimulating agents (ESA) in oncologic patients remains controversial. Since 2007, the FDA has included the addition of a black box label warning and the implementation of a risk management program for ESA prescription. Regarding treatment with ESA in patients with multiple myeloma (MM), there are only three studies with discordant results.
Aims
The purpose of our study is to explore the impact of ESA on overall survival in a cohort of MM patients treated in our center.
Methods
Between 2002 and 2015, 212 patients were diagnosed of MM in our center. We excluded 55 patients: 23 patients with diagnosis of smoldering myeloma and 32 patients candidates for palliative care because of age and comorbidities. We collected demographic information, clinical and laboratory data, staging according International Score System (ISS), regimens of treatment, overall survival (OS) as well as information on erythropoietin use for all patients.
Results
One hundred and fifty five patients were included: 63 received recombinant human erythropoietin (rhEPO) at least 1 month. The median total dose was 440000 international units (IU) (range 40000 – 10920000). Patient’s characteristics according EPO therapy are presented in table. Patients treated with rhEPO showed more advanced stages, higher creatinine levels and required hemodialysis more frequently. Nevertheless autologous stem cell transplantation was performed more frequently in non-EPO patients. There was no difference in first line therapy between rhEPO and non-EPO patients. The median OS in all patients was 31 months (CI95% 22.67-39.33) and we did not observe differences between EPO and non-EPO groups (35 vs. 31 months, Log Rank p=0.96). However, when looking at the influence of total EPO doses on outcome, we observed differences in OS between patients who received doses of EPO > 400000 IU, vs. patients with lower doses or untreated (50 vs. 23 months, Log Rank p=0.047). Multivariate analysis (Cox Regression) showed, age, albumin, Beta 2 microglobulin and rhEPO doses as independent prognostic factors for OS.
| TABLE 1. | No rhEPO use | rhEPO use | p value |
| Patients: | 94 | 63 | |
| Age at diagnosis: median (range) | 70 (33-89) | 74 (36-87) | 0.057* |
| Male/ Female | 49 (51)/ 47 (49) | 33 (54.1)/ 28 (45.9) | 0.417** |
| Laboratory findings: median (range) | |||
| Hemoglobin, g/dL | 10.05 (4.7-15.7) | 10.10 (6.7-14.1) | 0.459* |
| Creatinine, mg/dL | 1.11 (0.49-6.63) | 2.21 (0.63-13.94) | 0.0001* |
| Albumin, g/dL | 3.55 (1.9-5.0) | 3.5 (2.1-5.4) | 0.647* |
| Beta-2 microglobulin mg/L | 4.794 (1.140-36.247) | 7.492 (1.955-48.960) | 0.03* |
| ISS III, No., (%) | 40 (41.7) | 41 (67.2) | |
| Treatments: No., (%) | |||
| Hemodialyzed patients | 2 (2.1) | 20 (32.8) | 0.0001** |
| Autologous Stem Cell Transplant | 15 (15.6) | 3 (4.9) | 0.043** |
| Melphalan-Prednisone (MP) | 21 (21.9) | 17 (27.8) | 0,162*** |
| Bortezomib Regimens | 59 (61.5) | 40 (65.6) | |
| Others Regimens | 16 (16.7) | 4 (6.6) | |
| Overall Survival: median (CI95%) | 31 (20.58-41.42) | 35 (18.61-51.39) | 0.963 (Log-Rank test) |
Conclusion
The use of rhEPO does not have a negative effect in MM patients. Our study suggests that treatment with high doses of rhEPO could have a positive impact to improved OS. However, prospective randomized studies to confirm these data are required.
Session topic: E-poster
Keyword(s): Erythropoietin, Multiple myeloma
Abstract: PB1969
Type: Publication Only
Background
Treatment with erythropoiesis stimulating agents (ESA) in oncologic patients remains controversial. Since 2007, the FDA has included the addition of a black box label warning and the implementation of a risk management program for ESA prescription. Regarding treatment with ESA in patients with multiple myeloma (MM), there are only three studies with discordant results.
Aims
The purpose of our study is to explore the impact of ESA on overall survival in a cohort of MM patients treated in our center.
Methods
Between 2002 and 2015, 212 patients were diagnosed of MM in our center. We excluded 55 patients: 23 patients with diagnosis of smoldering myeloma and 32 patients candidates for palliative care because of age and comorbidities. We collected demographic information, clinical and laboratory data, staging according International Score System (ISS), regimens of treatment, overall survival (OS) as well as information on erythropoietin use for all patients.
Results
One hundred and fifty five patients were included: 63 received recombinant human erythropoietin (rhEPO) at least 1 month. The median total dose was 440000 international units (IU) (range 40000 – 10920000). Patient’s characteristics according EPO therapy are presented in table. Patients treated with rhEPO showed more advanced stages, higher creatinine levels and required hemodialysis more frequently. Nevertheless autologous stem cell transplantation was performed more frequently in non-EPO patients. There was no difference in first line therapy between rhEPO and non-EPO patients. The median OS in all patients was 31 months (CI95% 22.67-39.33) and we did not observe differences between EPO and non-EPO groups (35 vs. 31 months, Log Rank p=0.96). However, when looking at the influence of total EPO doses on outcome, we observed differences in OS between patients who received doses of EPO > 400000 IU, vs. patients with lower doses or untreated (50 vs. 23 months, Log Rank p=0.047). Multivariate analysis (Cox Regression) showed, age, albumin, Beta 2 microglobulin and rhEPO doses as independent prognostic factors for OS.
*UMW: U-Mann-Whitney, **Fisher test, ***Chi-square test
Conclusion
The use of rhEPO does not have a negative effect in MM patients. Our study suggests that treatment with high doses of rhEPO could have a positive impact to improved OS. However, prospective randomized studies to confirm these data are required.
Session topic: E-poster
Keyword(s): Erythropoietin, Multiple myeloma
Type: Publication Only
Background
Treatment with erythropoiesis stimulating agents (ESA) in oncologic patients remains controversial. Since 2007, the FDA has included the addition of a black box label warning and the implementation of a risk management program for ESA prescription. Regarding treatment with ESA in patients with multiple myeloma (MM), there are only three studies with discordant results.
Aims
The purpose of our study is to explore the impact of ESA on overall survival in a cohort of MM patients treated in our center.
Methods
Between 2002 and 2015, 212 patients were diagnosed of MM in our center. We excluded 55 patients: 23 patients with diagnosis of smoldering myeloma and 32 patients candidates for palliative care because of age and comorbidities. We collected demographic information, clinical and laboratory data, staging according International Score System (ISS), regimens of treatment, overall survival (OS) as well as information on erythropoietin use for all patients.
Results
One hundred and fifty five patients were included: 63 received recombinant human erythropoietin (rhEPO) at least 1 month. The median total dose was 440000 international units (IU) (range 40000 – 10920000). Patient’s characteristics according EPO therapy are presented in table. Patients treated with rhEPO showed more advanced stages, higher creatinine levels and required hemodialysis more frequently. Nevertheless autologous stem cell transplantation was performed more frequently in non-EPO patients. There was no difference in first line therapy between rhEPO and non-EPO patients. The median OS in all patients was 31 months (CI95% 22.67-39.33) and we did not observe differences between EPO and non-EPO groups (35 vs. 31 months, Log Rank p=0.96). However, when looking at the influence of total EPO doses on outcome, we observed differences in OS between patients who received doses of EPO > 400000 IU, vs. patients with lower doses or untreated (50 vs. 23 months, Log Rank p=0.047). Multivariate analysis (Cox Regression) showed, age, albumin, Beta 2 microglobulin and rhEPO doses as independent prognostic factors for OS.
| TABLE 1. | No rhEPO use | rhEPO use | p value |
| Patients: | 94 | 63 | |
| Age at diagnosis: median (range) | 70 (33-89) | 74 (36-87) | 0.057* |
| Male/ Female | 49 (51)/ 47 (49) | 33 (54.1)/ 28 (45.9) | 0.417** |
| Laboratory findings: median (range) | |||
| Hemoglobin, g/dL | 10.05 (4.7-15.7) | 10.10 (6.7-14.1) | 0.459* |
| Creatinine, mg/dL | 1.11 (0.49-6.63) | 2.21 (0.63-13.94) | 0.0001* |
| Albumin, g/dL | 3.55 (1.9-5.0) | 3.5 (2.1-5.4) | 0.647* |
| Beta-2 microglobulin mg/L | 4.794 (1.140-36.247) | 7.492 (1.955-48.960) | 0.03* |
| ISS III, No., (%) | 40 (41.7) | 41 (67.2) | |
| Treatments: No., (%) | |||
| Hemodialyzed patients | 2 (2.1) | 20 (32.8) | 0.0001** |
| Autologous Stem Cell Transplant | 15 (15.6) | 3 (4.9) | 0.043** |
| Melphalan-Prednisone (MP) | 21 (21.9) | 17 (27.8) | 0,162*** |
| Bortezomib Regimens | 59 (61.5) | 40 (65.6) | |
| Others Regimens | 16 (16.7) | 4 (6.6) | |
| Overall Survival: median (CI95%) | 31 (20.58-41.42) | 35 (18.61-51.39) | 0.963 (Log-Rank test) |
Conclusion
The use of rhEPO does not have a negative effect in MM patients. Our study suggests that treatment with high doses of rhEPO could have a positive impact to improved OS. However, prospective randomized studies to confirm these data are required.
Session topic: E-poster
Keyword(s): Erythropoietin, Multiple myeloma
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