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VARIATION IN USE OF IMMUNOGLOBULIN AND IMPACT ON SURVIVAL IN MULTIPLE MYELOMA: A REPORT FROM THE AUSTRALIA/NEW ZEALAND (ANZ) AND ASIA-PACIFIC (APAC) MYELOMA AND RELATED DISEASES REGISTRIES (MRDR)
Author(s): ,
Khai Li Chai
Affiliations:
Transfusion Research Unit, School of Public Health and Preventive Medicine,Monash University,Melbourne,Australie;Transfusion Research Unit, School of Public Health and Preventive Medicine,Monash University,Melbourne,Australien;Transfusion Research Unit, School of Public Health and Preventive Medicine,Monash University,Melbourne,Australia;Transfusion Research Unit, School of Public Health and Preve
,
Cameron Wellard
Affiliations:
Transfusion Research Unit, School of Public Health and Preventive Medicine,Monash University,Melbourne,Australie;Transfusion Research Unit, School of Public Health and Preventive Medicine,Monash University,Melbourne,Australien;Transfusion Research Unit, School of Public Health and Preventive Medicine,Monash University,Melbourne,Australia;Transfusion Research Unit, School of Public Health and Preve
,
Naomi Aoki
Affiliations:
Transfusion Research Unit, School of Public Health and Preventive Medicine,Monash University,Melbourne,Australie;Transfusion Research Unit, School of Public Health and Preventive Medicine,Monash University,Melbourne,Australien;Transfusion Research Unit, School of Public Health and Preventive Medicine,Monash University,Melbourne,Australia;Transfusion Research Unit, School of Public Health and Preve
,
Elizabeth M. Moore
Affiliations:
Transfusion Research Unit, School of Public Health and Preventive Medicine,Monash University,Melbourne,Australie;Transfusion Research Unit, School of Public Health and Preventive Medicine,Monash University,Melbourne,Australien;Transfusion Research Unit, School of Public Health and Preventive Medicine,Monash University,Melbourne,Australia;Transfusion Research Unit, School of Public Health and Preve
,
Bradley Augustson
Affiliations:
Department of Haematology,Sir Charles Gairdner Hospital,Perth,Australie;Department of Haematology,Sir Charles Gairdner Hospital,Perth,Australien;Department of Haematology,Sir Charles Gairdner Hospital,Perth,Australia;Department of Haematology,Sir Charles Gairdner Hospital,Perth,Australia;Department of Haematology,Sir Charles Gairdner Hospital,Perth,Australia;Department of Haematology,Sir Charles G
,
Akshay Bapat
Affiliations:
Department of Haematology,Royal Hobart Hospital,Hobart,Australie;Department of Haematology,Royal Hobart Hospital,Hobart,Australien;Department of Haematology,Royal Hobart Hospital,Hobart,Australia;Department of Haematology,Royal Hobart Hospital,Hobart,Australia;Department of Haematology,Royal Hobart Hospital,Hobart,Australia;Department of Haematology,Royal Hobart Hospital,Hobart,Australië;Departmen
,
Hilary Anne Blacklock
Affiliations:
Department of Haematology,Middlemore Hospital,Auckland,Nouvelle-zélande;Department of Haematology,Middlemore Hospital,Auckland,Neuseeland;Department of Haematology,Middlemore Hospital,Auckland,Nuova Zelanda;Department of Haematology,Middlemore Hospital,Auckland,新西兰;Department of Haematology,Middlemore Hospital,Auckland,Nueva Zelanda;Department of Haematology,Middlemore Hospital,Auckland,Nieuw Zeel
,
Wee Joo Chng
Affiliations:
Department of Haematology,National University Hospital,Singapore,Singapour;Department of Haematology,National University Hospital,Singapore,Singapur;Department of Haematology,National University Hospital,Singapore,Singapore;Department of Haematology,National University Hospital,Singapore,新加坡;Department of Haematology,National University Hospital,Singapore,Singapur;Department of Haematology,Nationa
,
Rachel Cooke
Affiliations:
Department of Haematology,Northern Hospital,Melbourne,Australie;Department of Haematology,Northern Hospital,Melbourne,Australien;Department of Haematology,Northern Hospital,Melbourne,Australia;Department of Haematology,Northern Hospital,Melbourne,Australia;Department of Haematology,Northern Hospital,Melbourne,Australia;Department of Haematology,Northern Hospital,Melbourne,Australië;Department of H
,
Cecily Forsyth
Affiliations:
Department of Haematology,Gosford Hospital,Gosford,Australie;Department of Haematology,Gosford Hospital,Gosford,Australien;Department of Haematology,Gosford Hospital,Gosford,Australia;Department of Haematology,Gosford Hospital,Gosford,Australia;Department of Haematology,Gosford Hospital,Gosford,Australia;Department of Haematology,Gosford Hospital,Gosford,Australië;Department of Haematology,Gosford
,
Nada Hamad
Affiliations:
Department of Haematology,St Vincent's Hospital Sydney,Sydney,Australie;Department of Haematology,St Vincent's Hospital Sydney,Sydney,Australien;Department of Haematology,St Vincent's Hospital Sydney,Sydney,Australia;Department of Haematology,St Vincent's Hospital Sydney,Sydney,Australia;Department of Haematology,St Vincent's Hospital Sydney,Sydney,Australia;Department of Haematology,St Vincent's
,
Simon J. Harrison
Affiliations:
Department of Haematology,Peter MacCallum Cancer Centre and the Royal Melbourne Hospital,Melbourne,Australie;Department of Haematology,Peter MacCallum Cancer Centre and the Royal Melbourne Hospital,Melbourne,Australien;Department of Haematology,Peter MacCallum Cancer Centre and the Royal Melbourne Hospital,Melbourne,Australia;Department of Haematology,Peter MacCallum Cancer Centre and the Royal Me
,
Phoebe Joy Ho
Affiliations:
Department of Haematology,Royal Prince Alfred Hospital,Sydney,Australie;Department of Haematology,Royal Prince Alfred Hospital,Sydney,Australien;Department of Haematology,Royal Prince Alfred Hospital,Sydney,Australia;Department of Haematology,Royal Prince Alfred Hospital,Sydney,Australia;Department of Haematology,Royal Prince Alfred Hospital,Sydney,Australia;Department of Haematology,Royal Prince
,
Jay Hocking
Affiliations:
Department of Haematology,Box Hill Hospital,Melbourne,Australie;Department of Haematology,Box Hill Hospital,Melbourne,Australien;Department of Haematology,Box Hill Hospital,Melbourne,Australia;Department of Haematology,Box Hill Hospital,Melbourne,Australia;Department of Haematology,Box Hill Hospital,Melbourne,Australia;Department of Haematology,Box Hill Hospital,Melbourne,Australië;Department of H
,
Ian H. Kerridge
Affiliations:
Department of Haematology,Royal North Shore Hospital,Sydney,Australie;Department of Haematology,Royal North Shore Hospital,Sydney,Australien;Department of Haematology,Royal North Shore Hospital,Sydney,Australia;Department of Haematology,Royal North Shore Hospital,Sydney,Australia;Department of Haematology,Royal North Shore Hospital,Sydney,Australia;Department of Haematology,Royal North Shore Hospi
,
Jin Seok Kim
Affiliations:
Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine,Severance Hospital,Seoul,Corée, République De;Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine,Severance Hospital,Seoul,Corea del Sud;Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine,Severance Hospital,Seoul,South
,
Kihyun Kim
Affiliations:
Division of Hematology-Oncology, Department of Medicine,Samsung Medical Center,Seoul,Corée, République De;Division of Hematology-Oncology, Department of Medicine,Samsung Medical Center,Seoul,Corea del Sud;Division of Hematology-Oncology, Department of Medicine,Samsung Medical Center,Seoul,South Korea,Republic;Division of Hematology-Oncology, Department of Medicine,Samsung Medical Center,Seoul,Zuid
,
Tracy King
Affiliations:
Department of Haematology,Royal Prince Alfred Hospital,Sydney,Australie;Department of Haematology,Royal Prince Alfred Hospital,Sydney,Australien;Department of Haematology,Royal Prince Alfred Hospital,Sydney,Australia;Department of Haematology,Royal Prince Alfred Hospital,Sydney,Australia;Department of Haematology,Royal Prince Alfred Hospital,Sydney,Australia;Department of Haematology,Royal Prince
,
Georgia J. McCaughan
Affiliations:
Department of Haematology,St Vincent's Hospital Sydney,Sydney,Australie;Department of Haematology,St Vincent's Hospital Sydney,Sydney,Australien;Department of Haematology,St Vincent's Hospital Sydney,Sydney,Australia;Department of Haematology,St Vincent's Hospital Sydney,Sydney,Australia;Department of Haematology,St Vincent's Hospital Sydney,Sydney,Australia;Department of Haematology,St Vincent's
,
Peter Mollee
Affiliations:
Department of Haematology,Princess Alexandra Hospital,Brisbane,Australie;Department of Haematology,Princess Alexandra Hospital,Brisbane,Australien;Department of Haematology,Princess Alexandra Hospital,Brisbane,Australia;Department of Haematology,Princess Alexandra Hospital,Brisbane,Australia;Department of Haematology,Princess Alexandra Hospital,Brisbane,Australia;Department of Haematology,Princess
,
C. Orla Morrissey
Affiliations:
Department of Infectious Diseases,The Alfred Hospital and Monash University,Melbourne,Australie;Department of Infectious Diseases,The Alfred Hospital and Monash University,Melbourne,Australien;Department of Infectious Diseases,The Alfred Hospital and Monash University,Melbourne,Australia;Department of Infectious Diseases,The Alfred Hospital and Monash University,Melbourne,Australia;Department of I
,
Nicholas Murphy
Affiliations:
Department of Haematology,Royal Hobart Hospital,Hobart,Australie;Department of Haematology,Royal Hobart Hospital,Hobart,Australien;Department of Haematology,Royal Hobart Hospital,Hobart,Australia;Department of Haematology,Royal Hobart Hospital,Hobart,Australia;Department of Haematology,Royal Hobart Hospital,Hobart,Australia;Department of Haematology,Royal Hobart Hospital,Hobart,Australië;Departmen
,
Hang Quach
Affiliations:
Department of Haematology,St Vincent's Hospital Melbourne,Melbourne,Australie;Department of Haematology,St Vincent's Hospital Melbourne,Melbourne,Australien;Department of Haematology,St Vincent's Hospital Melbourne,Melbourne,Australia;Department of Haematology,St Vincent's Hospital Melbourne,Melbourne,Australia;Department of Haematology,St Vincent's Hospital Melbourne,Melbourne,Australia;Departmen
,
Xuan Ni Tan
Affiliations:
Department of Haematology,Sir Charles Gairdner Hospital,Perth,Australie;Department of Haematology,Sir Charles Gairdner Hospital,Perth,Australien;Department of Haematology,Sir Charles Gairdner Hospital,Perth,Australia;Department of Haematology,Sir Charles Gairdner Hospital,Perth,Australia;Department of Haematology,Sir Charles Gairdner Hospital,Perth,Australia;Department of Haematology,Sir Charles G
,
Allison Tso
Affiliations:
Department of Haematology,Tan Tock Seng Hospital,Singapore,Singapour;Department of Haematology,Tan Tock Seng Hospital,Singapore,Singapur;Department of Haematology,Tan Tock Seng Hospital,Singapore,Singapore;Department of Haematology,Tan Tock Seng Hospital,Singapore,新加坡;Department of Haematology,Tan Tock Seng Hospital,Singapore,Singapur;Department of Haematology,Tan Tock Seng Hospital,Singapore,Sing
,
Kimberly Wong
Affiliations:
Department of Haematology,Box Hill Hospital,Melbourne,Australie;Department of Haematology,Box Hill Hospital,Melbourne,Australien;Department of Haematology,Box Hill Hospital,Melbourne,Australia;Department of Haematology,Box Hill Hospital,Melbourne,Australia;Department of Haematology,Box Hill Hospital,Melbourne,Australia;Department of Haematology,Box Hill Hospital,Melbourne,Australië;Department of H
,
Andrew Spencer
Affiliations:
Department of Haematology,The Alfred Hospital,Melbourne,Australie;Department of Haematology,The Alfred Hospital,Melbourne,Australien;Department of Haematology,The Alfred Hospital,Melbourne,Australia;Department of Haematology,The Alfred Hospital,Melbourne,Australia;Department of Haematology,The Alfred Hospital,Melbourne,Australia;Department of Haematology,The Alfred Hospital,Melbourne,Australië;Dep
,
Erica M. Wood
Affiliations:
Transfusion Research Unit, School of Public Health and Preventive Medicine,Monash University,Melbourne,Australie;Transfusion Research Unit, School of Public Health and Preventive Medicine,Monash University,Melbourne,Australien;Transfusion Research Unit, School of Public Health and Preventive Medicine,Monash University,Melbourne,Australia;Transfusion Research Unit, School of Public Health and Preve
Zoe K. McQuilten
Affiliations:
Transfusion Research Unit, School of Public Health and Preventive Medicine,Monash University,Melbourne,Australie;Transfusion Research Unit, School of Public Health and Preventive Medicine,Monash University,Melbourne,Australien;Transfusion Research Unit, School of Public Health and Preventive Medicine,Monash University,Melbourne,Australia;Transfusion Research Unit, School of Public Health and Preve
(Abstract release date: 05/12/22) EHA Library. Li Chai K. 06/10/22; 358430; P1573
Khai Li Chai
Khai Li Chai
Contributions
Abstract
Presentation during EHA2022: All (e)Poster presentations will be made available as of Friday, June 10, 2022 (09:00 CEST) and will be accessible for on-demand viewing until Monday, August 15, 2022 on the Congress platform.

Abstract: P1573

Type: Poster presentation

Session title: Infections in hematology (incl. supportive care/therapy)

Background
Serious infection is common in patients with multiple myeloma (MM), and associated with major morbidity and mortality. Immunoglobulin (Ig) replacement is frequently used to reduce infections, but this is based on small trials conducted >20 years ago. Guidelines for Ig use in MM patients vary between countries. Use of Ig and associated costs are increasing worldwide.

Aims

This study aims to outline Ig use in the “real-world MM” setting, identify variation in practice and predictors of use, and describe association with survival outcomes.

Methods

Retrospective review of patients registered on the ANZ and APAC MRDR with a diagnosis of MM or plasma cell leukaemia from sites with verifiable data regarding Ig. Survival and cause of death data (COD) was augmented via linkage with national death registries for ANZ patients. Patient/disease characteristics, therapy and survival were compared between patients who received Ig by 24 months of diagnosis and patients who did not, using chi-square tests for categorical variables and rank sum tests for continuous variables. Variation in Ig use across sites was compared. Kaplan-Meier survival analysis was used to estimate duration of Ig use. Time-dependent Cox analysis was used to compare survival for patients whilst on and off Ig therapy. All statistical analysis was completed on STATAv16.1.

Results

2445 patients with a median follow-up time of 30 months were included in this analysis - 1744 from Australia (12 sites), 313 Korea (3 sites), 281 New Zealand (1 site) and 107 Singapore (3 sites). Of patients reaching 12-month follow-up post MM-diagnosis, 6.4% received Ig and of patients reaching 24-month follow-up, 7.0% received Ig. 69% of these Ig-users were estimated to receive over 24 months duration of Ig. Administration varied by country – between 0 to 17% of patients by country who reached 24 months follow-up received Ig. Patients who received Ig by 24 months of MM-diagnosis were younger, had lower baseline IgG and Ig levels, more likely to have abnormal FISH, receive first-line IMiDs, anti-CD38 therapy and ASCT (Table 1).

Ig use was not associated with overall survival benefit (HR=0.72, 0.46-1.14, p=0.16). Baseline Ig levels were also not found to be associated with overall survival. At time of last follow-up, there were 623 deaths (25.4%). Available data on COD was available for 175 deaths in ANZ patients. Of these, 65 deaths (37.1%) had infection listed as primary/secondary COD. 64 of these 65 infection-related deaths occurred in patients who did not receive Ig. In patients who received Ig (at any time), 12.5% had infection as primary/secondary COD, compared to 38.5% in non-recipients (p=0.14).

Conclusion
In this real-world cohort, use of Ig varied between countries and was associated with lower baseline IgG, abnormal FISH, and first-line therapy with IMiD, anti-CD38 and ASCT. Ig use was not associated with overall survival, highlighting the need for contemporary studies to inform patient selection, especially with rising use of Ig and targeted anti-myeloma therapies, and a high burden of infection-related mortality.

Keyword(s): Immunoglobulin, Infection

Presentation during EHA2022: All (e)Poster presentations will be made available as of Friday, June 10, 2022 (09:00 CEST) and will be accessible for on-demand viewing until Monday, August 15, 2022 on the Congress platform.

Abstract: P1573

Type: Poster presentation

Session title: Infections in hematology (incl. supportive care/therapy)

Background
Serious infection is common in patients with multiple myeloma (MM), and associated with major morbidity and mortality. Immunoglobulin (Ig) replacement is frequently used to reduce infections, but this is based on small trials conducted >20 years ago. Guidelines for Ig use in MM patients vary between countries. Use of Ig and associated costs are increasing worldwide.

Aims

This study aims to outline Ig use in the “real-world MM” setting, identify variation in practice and predictors of use, and describe association with survival outcomes.

Methods

Retrospective review of patients registered on the ANZ and APAC MRDR with a diagnosis of MM or plasma cell leukaemia from sites with verifiable data regarding Ig. Survival and cause of death data (COD) was augmented via linkage with national death registries for ANZ patients. Patient/disease characteristics, therapy and survival were compared between patients who received Ig by 24 months of diagnosis and patients who did not, using chi-square tests for categorical variables and rank sum tests for continuous variables. Variation in Ig use across sites was compared. Kaplan-Meier survival analysis was used to estimate duration of Ig use. Time-dependent Cox analysis was used to compare survival for patients whilst on and off Ig therapy. All statistical analysis was completed on STATAv16.1.

Results

2445 patients with a median follow-up time of 30 months were included in this analysis - 1744 from Australia (12 sites), 313 Korea (3 sites), 281 New Zealand (1 site) and 107 Singapore (3 sites). Of patients reaching 12-month follow-up post MM-diagnosis, 6.4% received Ig and of patients reaching 24-month follow-up, 7.0% received Ig. 69% of these Ig-users were estimated to receive over 24 months duration of Ig. Administration varied by country – between 0 to 17% of patients by country who reached 24 months follow-up received Ig. Patients who received Ig by 24 months of MM-diagnosis were younger, had lower baseline IgG and Ig levels, more likely to have abnormal FISH, receive first-line IMiDs, anti-CD38 therapy and ASCT (Table 1).

Ig use was not associated with overall survival benefit (HR=0.72, 0.46-1.14, p=0.16). Baseline Ig levels were also not found to be associated with overall survival. At time of last follow-up, there were 623 deaths (25.4%). Available data on COD was available for 175 deaths in ANZ patients. Of these, 65 deaths (37.1%) had infection listed as primary/secondary COD. 64 of these 65 infection-related deaths occurred in patients who did not receive Ig. In patients who received Ig (at any time), 12.5% had infection as primary/secondary COD, compared to 38.5% in non-recipients (p=0.14).

Conclusion
In this real-world cohort, use of Ig varied between countries and was associated with lower baseline IgG, abnormal FISH, and first-line therapy with IMiD, anti-CD38 and ASCT. Ig use was not associated with overall survival, highlighting the need for contemporary studies to inform patient selection, especially with rising use of Ig and targeted anti-myeloma therapies, and a high burden of infection-related mortality.

Keyword(s): Immunoglobulin, Infection

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