THE MYELOMA LANDSCAPE IN AUSTRALIA AND NEW ZEALAND (ANZ): THE FIRST SEVEN YEARS OF THE MYELOMA AND RELATED DISEASES REGISTRY (MRDR)
Author(s): ,
Krystal Bergin
Affiliations:
The Alfred/Monash University,Melbourne,Australia
,
Cameron Wellard
Affiliations:
Department Epidemiology and Preventive Medicine,Monash University,Melbourne,Australia
,
Elizabeth Moore
Affiliations:
Department Epidemiology and Preventive Medicine,Monash University,Melbourne,Australia
,
Zoe McQuilten
Affiliations:
Department Epidemiology and Preventive Medicine,Monash University,Melbourne,Australia
,
Erica Wood
Affiliations:
Department Epidemiology and Preventive Medicine,Monash University,Melbourne,Australia
,
Hang Quach
Affiliations:
St.Vincent’s Hospital/University of Melbourne,Melbourne,Australia
,
Hilary Blacklock
Affiliations:
Middlemore Hospital,Middlemore,New Zealand
,
Peter Mollee
Affiliations:
Princess Alexandra Hospital,Brisbane,Australia
,
Joy Ho
Affiliations:
Royal Prince Alfred ,Sydney,Australia
,
Patricia Walker
Affiliations:
Peninsula Health,Melbourne,Australia
,
Bradley Auguston
Affiliations:
12Sir Charles Gairdner Hospital,Perth,Australia
,
John McNeil
Affiliations:
Department Epidemiology and Preventive Medicine,Monash University,Melbourne,Australia
,
Brian Rosengarten
Affiliations:
Myeloma Australia,Melbourne,Australia
,
Simon Harrison
Affiliations:
Peter MacCallum Cancer Centre/Melbourne University,Melbourne,Australia
,
Tracy King
Affiliations:
Royal Prince Alfred,Sydney,Australia
Andrew Spencer
Affiliations:
The Alfred/Monash University,Melbourne,Australia
(Abstract release date: 05/14/20) EHA Library. Bergin K. 06/12/20; 297945; PB2029
Krystal Bergin
Krystal Bergin
Contributions
Abstract

Abstract: PB2029

Type: Publication Only

Background

“Real world” epidemiological and outcome data for multiple myeloma (MM) are scarce with most data originating from clinical trials. The Myeloma and Related Diseases Registry (MRDR) is a prospective clinical quality registry of incident cases of plasma cell disorders established in 2012 and now operating at 38 sites in Australia and New Zealand.

Aims
To describe the charactistics and diagnostic/therapy patterns of MM patients in real world Australia/New Zealand population.

Methods

We reviewed all MRDR patients with a diagnosis of MM by International Myeloma Working Group (IMWG) criteria enrolled onto the MRDR between June 2012 and August 2019. Baseline characteristics, treatment, and outcome data were reviewed with comparisons made using chi-square tests for categorical variables and rank sum tests for continuous variables. Kaplan-Meier analysis was used to estimate progression free (PFS) and overall survival (OS).

Results

A total of 2776 patients were enrolled on the MRDR as of the 1st of August 2019. Sixty-nine percent (1913 patients) were recorded to have MM with bone lesions being the most commonly documented diagnostic CRAB criteria (61%). Median age was 67 years with 38% being older than 70y and 60% were male. High-risk features were present in 13-32% of patients - FISH [t(4;14), t(14;16) or del17p] 18%, ISS 3 32%, R-ISS 3 13%. Sixteen percent had extra-medullary disease at diagnosis. Light chain-only disease accounted for 19% of diagnoses and 1.2% patients had non-secretory disease. Cytogenetics and/or FISH were performed in 50% and 66% of patients, respectively with 32% of those tested having an abnormal karyotype. Baseline skeletal imaging was performed in 84% (1603/1913) of cases: skeletal survey (SS): 43.8%, CT: 29.7%, MRI: 26.8%. In patients with no lytic lesions on SS (37%, n=310), 94 had further imaging by another modality that identified lytic bone disease in 65 (69.1%) patients. Of patients with available treatment data (n=1726), 83% achieved ≥ a partial response (PR), including complete response (CR) in 10%.  Bortezomib-based induction was most common (85%, n=1462). Patients receiving non-bortezomib-based induction were older than those receiving bortezomib (median age 75y (IQR, 67, 82) versus 65y (IQR, 58, 72), p<0.001), respectively, and had a higher ECOG performance status (ECOG ≥2: 41% versus 18%, p<0.001, respectively). Only 72% of patients not receiving bortezomib achieved ≥PR. Median PFS (whole MM cohort) was 30.4 months with those receiving bortezomib-based therapy demonstrating improved PFS compared to those not receiving bortezomib (30.9m versus 28.5m, p=0.014, respectively). Median OS (total MM cohort) was 60.6 months. Patients with higher R-ISS demonstrated inferior OS (R-ISS 1 versus R-ISS 2 versus R-ISS 3; not reached, 64 months and 32.8 months, p<0.001, respectively). 

Conclusion

Clinical registries, such as the MRDR, are powerful tools which complement the results of clinical trials and can measure how these findings are applied in routine clinical practice.  Timely risk stratification at diagnosis is necessary for prognostication and to guide treatment decisions. Application of prognostic scores, such as the R-ISS, is often hampered by limited availability of more complex, and often expensive, diagnostics and may diminish their usefulness in the real world.

Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical

Keyword(s): Myeloma, Outcome, Practice

Abstract: PB2029

Type: Publication Only

Background

“Real world” epidemiological and outcome data for multiple myeloma (MM) are scarce with most data originating from clinical trials. The Myeloma and Related Diseases Registry (MRDR) is a prospective clinical quality registry of incident cases of plasma cell disorders established in 2012 and now operating at 38 sites in Australia and New Zealand.

Aims
To describe the charactistics and diagnostic/therapy patterns of MM patients in real world Australia/New Zealand population.

Methods

We reviewed all MRDR patients with a diagnosis of MM by International Myeloma Working Group (IMWG) criteria enrolled onto the MRDR between June 2012 and August 2019. Baseline characteristics, treatment, and outcome data were reviewed with comparisons made using chi-square tests for categorical variables and rank sum tests for continuous variables. Kaplan-Meier analysis was used to estimate progression free (PFS) and overall survival (OS).

Results

A total of 2776 patients were enrolled on the MRDR as of the 1st of August 2019. Sixty-nine percent (1913 patients) were recorded to have MM with bone lesions being the most commonly documented diagnostic CRAB criteria (61%). Median age was 67 years with 38% being older than 70y and 60% were male. High-risk features were present in 13-32% of patients - FISH [t(4;14), t(14;16) or del17p] 18%, ISS 3 32%, R-ISS 3 13%. Sixteen percent had extra-medullary disease at diagnosis. Light chain-only disease accounted for 19% of diagnoses and 1.2% patients had non-secretory disease. Cytogenetics and/or FISH were performed in 50% and 66% of patients, respectively with 32% of those tested having an abnormal karyotype. Baseline skeletal imaging was performed in 84% (1603/1913) of cases: skeletal survey (SS): 43.8%, CT: 29.7%, MRI: 26.8%. In patients with no lytic lesions on SS (37%, n=310), 94 had further imaging by another modality that identified lytic bone disease in 65 (69.1%) patients. Of patients with available treatment data (n=1726), 83% achieved ≥ a partial response (PR), including complete response (CR) in 10%.  Bortezomib-based induction was most common (85%, n=1462). Patients receiving non-bortezomib-based induction were older than those receiving bortezomib (median age 75y (IQR, 67, 82) versus 65y (IQR, 58, 72), p<0.001), respectively, and had a higher ECOG performance status (ECOG ≥2: 41% versus 18%, p<0.001, respectively). Only 72% of patients not receiving bortezomib achieved ≥PR. Median PFS (whole MM cohort) was 30.4 months with those receiving bortezomib-based therapy demonstrating improved PFS compared to those not receiving bortezomib (30.9m versus 28.5m, p=0.014, respectively). Median OS (total MM cohort) was 60.6 months. Patients with higher R-ISS demonstrated inferior OS (R-ISS 1 versus R-ISS 2 versus R-ISS 3; not reached, 64 months and 32.8 months, p<0.001, respectively). 

Conclusion

Clinical registries, such as the MRDR, are powerful tools which complement the results of clinical trials and can measure how these findings are applied in routine clinical practice.  Timely risk stratification at diagnosis is necessary for prognostication and to guide treatment decisions. Application of prognostic scores, such as the R-ISS, is often hampered by limited availability of more complex, and often expensive, diagnostics and may diminish their usefulness in the real world.

Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical

Keyword(s): Myeloma, Outcome, Practice

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