title: Improved survival in myeloma patients: starting to close in on the gap between elderly patients and a matched normal population.
abstract: The outcome for multiple myeloma patients has improved since the introduction of bortezomib, thalidomide and lenalidomide. However, studies comparing new and conventional treatment include selected patient groups. We investigated consecutive patients (n = 1638) diagnosed in a defined period and compared survival with a gender- and age-matched cohort Swedish population (n = 9 340 682). Median overall survival for non-high-dose treated patients was 2·8 years. The use of bortezomib, thalidomide or lenalidomide in first line therapy predicted a significantly longer overall survival (median 4·9 years) compared to conventional treatment (2·3 years). Among non-high-dose treated patients receiving at least 2 lines with bortezomib, thalidomide or lenalidomide, 69% and 63% have survived at 3 and 5 years as compared to 48% and 22% with conventional drugs and 88% and 79% in the matched cohort populations, respectively. The median overall survival in high-dose treated patients was 6·9 years. Of these patients, 84% survived at 3 years and 70% at 5 years as compared to 98% and 95% in the matched cohort population. Overall survival in the best non-high-dose treated outcome group is closing the gap with the matched cohort. Upfront use of new drugs is clearly better than waiting until later lines of treatment.
authors: Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors: Johan
authors: J
authors: Liwing
authors: Katarina
authors: K
authors: Uttervall
authors: Johan
authors: J
authors: Lund
authors: Anders
authors: A
authors: Aldrin
authors: Cecilie
authors: C
authors: Blimark
authors: Kristina
authors: K
authors: Carlson
authors: Jon
authors: J
authors: Enestig
authors: Max
authors: M
authors: Flogegård
authors: Karin
authors: K
authors: Forsberg
authors: Astrid
authors: A
authors: Gruber
authors: Helene
authors: H
authors: Haglöf Kviele
authors: Peter
authors: P
authors: Johansson
authors: Birgitta
authors: B
authors: Lauri
authors: Ulf-Henrik
authors: UH
authors: Mellqvist
authors: Agneta
authors: A
authors: Swedin
authors: Magnus
authors: M
authors: Svensson
authors: Per
authors: P
authors: Näsman
authors: Evren
authors: E
authors: Alici
authors: Gösta
authors: G
authors: Gahrton
authors: Johan
authors: J
authors: Aschan
authors: Hareth
authors: H
authors: Nahi
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001897:Boronic Acids / Q000008:administration & dosage / Q000627:therapeutic use; D000069286:Bortezomib; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D000077269:Lenalidomide; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000401:mortality*; D011719:Pyrazines / Q000008:administration & dosage / Q000627:therapeutic use; D012042:Registries; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D000077269:Lenalidomide
keywords: myeloma; population based; progression-free survival; time to next treatment; treatment sequencing