Contributions
Abstract: PB1682
Type: Publication Only
Session title: Myeloma and other monoclonal gammopathies - Clinical
Background
A risk-adapted algorithm for mitigation of skeletal-related events (SREs) in myeloma can help guide intensity and duration of bisphosphonate (BP) therapy.
Aims
The aim of study was to investigate characteristics of SREs and associate clinical with any laboratory factors which might predict a higher SRE risk in plasma cell dyscrasias.
Methods
Patients receiving treatment for plasma cell disorders between January 2016 and December 2020 were retrospectively identified. SREs were identified and defined as: humeral, femoral, vertebral, rib and other fractures, skeletal and pain-related procedures. Skeletal events were divided into 5 periods: A: occurring between presentation and induction; B: occurring from initiation to end of induction; C: from end of induction till biochemical relapse, D: from biochemical relapse/progression to second-line therapy; E: second-line therapy onwards.
Results
Included were 113 patients, with a median age of 66 years (range 28–83 years) of whom 44 were female and 69 were male. The diagnoses were: 108 active myeloma, 3 solitary plasmacytomas, 2 plasma cell leukaemia and 1 POEMS. Ninety (79.6%) patients received zoledronic acid, 6 (5.3%) received pamidronate, 5 (4.4%) received both drugs. Twelve (10.6%) patients did not receive BP.
There were 128 SREs identified during follow-up, with a median of 1 SRE per patient. Sixty-four (56.6%) patients experienced SREs: 23 (20.4%) had 1 SRE, 26 (23.0%) had 2 SREs, nine (8.0%) had three SREs, four (3.5%) had four SREs and two (1.8%) patients had five SREs. These occurred as follows: Period A: 53 (41.4%) SREs; Period B: 45 (35.2%), Period C: 22 (17.2%), Period D: 2 (1.6%) and Period E: 6 (4.7%) events. SREs included: 60 (46.9%) vertebral fractures, 21 (16.4%) radiotherapy treatments, 13 (10.2%) hospitalisations with bone pain, 8 (6.25%) rib fractures, and 11 (8.6%) orthopaedic and pain procedures. Three (2.7%) had cord compression, comprising 2.3% of SREs.There was no significant difference in the interval between diagnosis and administration of first dose of BP between the patients with SREs and those without.
Patients with SREs likely to be younger (median age 63.5 years vs 69 years, P=0.002), have light chain myeloma (P=0.025) and more than 4 lytic lesions on baseline imaging (P<0.001). There was no significant difference with respect to gender, immunoglobulin isotype, light chain type, ISS stage, cytogenetics, presence of hypercalcaemia, anaemia or renal impairment at diagnosis, and baseline alkaline phosphatase level. There was no difference in OS between those experiencing SREs and those who did not (P=0.555).
Conclusion
Our study found an SRE rate comparable to other European countries. Most occurred early following diagnosis. Baseline characteristics associated with increased risk of SREs include younger age, light chain myeloma and more than four lytic lesions on imaging. Identification of baseline risk factors for SREs may help us move towards a risk-adapted strategy.
Keyword(s): Bisphosphonate, Bone disease, Multiple myeloma
Abstract: PB1682
Type: Publication Only
Session title: Myeloma and other monoclonal gammopathies - Clinical
Background
A risk-adapted algorithm for mitigation of skeletal-related events (SREs) in myeloma can help guide intensity and duration of bisphosphonate (BP) therapy.
Aims
The aim of study was to investigate characteristics of SREs and associate clinical with any laboratory factors which might predict a higher SRE risk in plasma cell dyscrasias.
Methods
Patients receiving treatment for plasma cell disorders between January 2016 and December 2020 were retrospectively identified. SREs were identified and defined as: humeral, femoral, vertebral, rib and other fractures, skeletal and pain-related procedures. Skeletal events were divided into 5 periods: A: occurring between presentation and induction; B: occurring from initiation to end of induction; C: from end of induction till biochemical relapse, D: from biochemical relapse/progression to second-line therapy; E: second-line therapy onwards.
Results
Included were 113 patients, with a median age of 66 years (range 28–83 years) of whom 44 were female and 69 were male. The diagnoses were: 108 active myeloma, 3 solitary plasmacytomas, 2 plasma cell leukaemia and 1 POEMS. Ninety (79.6%) patients received zoledronic acid, 6 (5.3%) received pamidronate, 5 (4.4%) received both drugs. Twelve (10.6%) patients did not receive BP.
There were 128 SREs identified during follow-up, with a median of 1 SRE per patient. Sixty-four (56.6%) patients experienced SREs: 23 (20.4%) had 1 SRE, 26 (23.0%) had 2 SREs, nine (8.0%) had three SREs, four (3.5%) had four SREs and two (1.8%) patients had five SREs. These occurred as follows: Period A: 53 (41.4%) SREs; Period B: 45 (35.2%), Period C: 22 (17.2%), Period D: 2 (1.6%) and Period E: 6 (4.7%) events. SREs included: 60 (46.9%) vertebral fractures, 21 (16.4%) radiotherapy treatments, 13 (10.2%) hospitalisations with bone pain, 8 (6.25%) rib fractures, and 11 (8.6%) orthopaedic and pain procedures. Three (2.7%) had cord compression, comprising 2.3% of SREs.There was no significant difference in the interval between diagnosis and administration of first dose of BP between the patients with SREs and those without.
Patients with SREs likely to be younger (median age 63.5 years vs 69 years, P=0.002), have light chain myeloma (P=0.025) and more than 4 lytic lesions on baseline imaging (P<0.001). There was no significant difference with respect to gender, immunoglobulin isotype, light chain type, ISS stage, cytogenetics, presence of hypercalcaemia, anaemia or renal impairment at diagnosis, and baseline alkaline phosphatase level. There was no difference in OS between those experiencing SREs and those who did not (P=0.555).
Conclusion
Our study found an SRE rate comparable to other European countries. Most occurred early following diagnosis. Baseline characteristics associated with increased risk of SREs include younger age, light chain myeloma and more than four lytic lesions on imaging. Identification of baseline risk factors for SREs may help us move towards a risk-adapted strategy.
Keyword(s): Bisphosphonate, Bone disease, Multiple myeloma