From the Guidelines
Multiple myeloma prognosis has significantly improved over the past two decades, with many patients now living 5-10 years or longer after diagnosis, as reported in the most recent study 1. The prognosis of multiple myeloma varies widely depending on several factors, including age, stage at diagnosis, genetic abnormalities, kidney function, and response to treatment.
- Staging systems like the Revised International Staging System (R-ISS) help predict outcomes by considering serum albumin, beta-2 microglobulin levels, lactate dehydrogenase, and high-risk chromosomal abnormalities.
- Patients with Stage I disease typically have better outcomes (median survival >8 years) compared to those with Stage III disease (median survival around 3-4 years).
- Certain genetic abnormalities like deletion 17p, t(4;14), and t(14;16) are associated with poorer prognosis, as noted in 1 and 1.
- Age is another important factor, with younger patients generally having better outcomes.
- Treatment response is crucial - those achieving complete response or minimal residual disease negativity tend to have longer progression-free and overall survival.
- Modern treatment approaches, including proteasome inhibitors (bortezomib, carfilzomib), immunomodulatory drugs (lenalidomide, pomalidomide), monoclonal antibodies (daratumumab), and stem cell transplantation, have substantially improved survival outcomes for many patients with multiple myeloma, as discussed in 1 and 1. The most recent study 1 provides the most up-to-date information on the prognosis and treatment of multiple myeloma, and its findings should be prioritized in clinical decision-making.
From the FDA Drug Label
The median DOR was 7.8 months (95% CI: 5.6,9.2) in Study PX-171-003 A1 and 8.0 months (Range: 1.4,32.5) in Study PX-171-007. ISS Stage at Study Baseline: I (29%), II (38%), III (31%) in Study PX-171-003 A1. The median DOR was not reached in Study PX-171-004 Part 2.
The prognosis for multiple myeloma patients is variable and depends on several factors, including ISS stage, cytogenetics, and response to treatment.
- Key factors that influence prognosis include:
- ISS stage: Patients with ISS Stage I tend to have a better prognosis than those with ISS Stage III.
- Cytogenetics: Patients with poor prognosis cytogenetics tend to have a worse prognosis than those with normal/favorable cytogenetics.
- Response to treatment: Patients who achieve a complete response or very good partial response tend to have a better prognosis than those who achieve a partial response or stable disease. Based on the studies, the median duration of response (DOR) ranged from 7.8 to 8.0 months, indicating that patients with multiple myeloma may experience a variable response to treatment 2.
From the Research
Multiple Myeloma Prognosis
The prognosis of multiple myeloma patients has improved significantly with the introduction of novel therapies such as immunomodulation and proteasome inhibition 3.
Treatment Options
Several treatment options are available for multiple myeloma, including:
- Bortezomib-melphalan-prednisone (VMP) and continuous lenalidomide-dexamethasone (Rd) for transplant-ineligible patients 4
- Bortezomib with lenalidomide and dexamethasone (VRd) for patients with newly diagnosed myeloma without intent for immediate autologous stem-cell transplant 5
- Carfilzomib or bortezomib in combination with lenalidomide and dexamethasone for patients with newly diagnosed multiple myeloma without intention for immediate autologous stem-cell transplantation (ENDURANCE) 6
- Daratumumab, bortezomib, lenalidomide, and dexamethasone for multiple myeloma 7
High-Risk Multiple Myeloma
High-risk multiple myeloma is defined by the presence of certain chromosomal abnormalities, such as del(17p), t(4;14), or t(14;16) 3. Patients with high-risk multiple myeloma have a poorer prognosis and may require more aggressive treatment.
Treatment Outcomes
Treatment outcomes for multiple myeloma vary depending on the specific treatment regimen and patient population. For example:
- The VMP regimen was found to be equally effective as the Rd regimen in standard-risk patients, but improved progression-free survival and overall survival in high-risk patients 4
- The VRd regimen was found to improve progression-free survival and overall survival compared to the Rd regimen in patients with newly diagnosed myeloma without intent for immediate autologous stem-cell transplant 5
- The KRd regimen did not improve progression-free survival compared to the VRd regimen in patients with newly diagnosed multiple myeloma, and had more toxicity 6
- The addition of subcutaneous daratumumab to VRd induction and consolidation therapy and to lenalidomide maintenance therapy conferred a significant benefit with respect to progression-free survival among transplantation-eligible patients with newly diagnosed multiple myeloma 7