What is the life expectancy of a 74-year-old individual with multiple myeloma and a history of diabetes?

Life Expectancy for a 74-Year-Old with Multiple Myeloma

A 74-year-old with newly diagnosed multiple myeloma can expect a median survival of approximately 3-4 years (31-40 months) with standard treatment regimens, though this varies significantly based on disease stage, cytogenetics, treatment response, and the presence of diabetes as a comorbidity. 1, 2

Current Survival Data for This Age Group

The most relevant survival data for elderly patients comes from clinical trials specifically evaluating this population:

• Patients aged 65 or older treated with melphalan/prednisone/bortezomib (MPB) demonstrated a 3-year overall survival rate of 68.5%, meaning approximately two-thirds of patients in this age group survive at least 3 years. 1

• Patients treated with melphalan/prednisone/thalidomide (MPT) showed median overall survival of 40 months (approximately 3.3 years), compared to 31 months with older melphalan/prednisone regimens. 1

• The 5-year relative survival rate for multiple myeloma has improved to 58% during 2011-2017, representing substantial progress, though this includes all age groups and younger patients typically fare better. 2

Impact of Age 74 Specifically

At age 74, this patient falls into the "elderly" category but not the "very elderly" (≥75 years) group:

• Patients aged 65-74 years comprise approximately 35-41% of multiple myeloma patients in clinical trials, and outcomes in this age range are generally better than those ≥75 years. 1

• Advanced age increases the odds of receiving no treatment by 7% per year of age, which can significantly impact survival if treatment is delayed or withheld. 1

Critical Impact of Diabetes

The presence of diabetes substantially affects prognosis:

• Pre-existing diabetes is associated with a significantly higher all-cause mortality risk (hazard ratio 1.509,95% CI: 1.023-2.225, P=0.037) compared to patients without diabetes. 3

• Patients with diabetes have higher rates of renal impairment at diagnosis (serum creatinine ≥2.0 mg/dL) and lower rates of renal impairment reversal, which independently worsens prognosis. 3

• During treatment, 67.6% of diabetic patients experience hyperglycemia and 17.6% experience hypoglycemia, requiring antidiabetic therapy changes in approximately 29% of cases. 3

Factors That Determine Where This Patient Falls in the Survival Range

Disease stage and biology are the strongest predictors:

• International Staging System (ISS) Stage I patients have significantly better survival than Stage III patients, with β2-microglobulin and serum albumin levels being the key determinants. 1

• High-risk cytogenetics [del(13), t(4;14), del(17p)] are associated with poorer outcomes, and these features should be assessed via FISH analysis or conventional karyotyping. 1

• Renal function at diagnosis is critical: creatinine clearance <30 mL/min indicates worse prognosis, though modern bortezomib-based regimens show efficacy regardless of renal impairment. 1

Treatment Approach That Maximizes Survival

For a 74-year-old, bortezomib-based combinations are preferred over thalidomide-based regimens:

• Melphalan/prednisone/bortezomib (MPB) is a Category 1 recommendation and shows superior outcomes with median survival from start of subsequent therapy of 30.2 months after MPB versus 21.9 months after other regimens. 1

• MPB demonstrates efficacy unaffected by advanced age, renal impairment, and adverse cytogenetics, making it particularly suitable for elderly patients with comorbidities. 1

• Complete response (CR) rates are higher with MPB (11%) compared to MPT (2%), and CR is associated with improved survival in the non-transplant setting. 1

Important Caveats for This Patient

Diabetes management during myeloma treatment is critical:

• Dexamethasone, a cornerstone of most myeloma regimens, causes significant hyperglycemia in diabetic patients, requiring close glucose monitoring and frequent antidiabetic therapy adjustments. 3

• The combination of diabetes and myeloma increases infection risk, particularly pneumonia, which is already elevated with novel agents like daratumumab (31.3% grade ≥3 infections). 1

Comorbidity burden matters significantly:

• Patients with one comorbidity have 19% increased mortality risk (HR 1.19), with two comorbidities 38% increased risk (HR 1.38), and three or more comorbidities 72% increased risk (HR 1.72). 4

• Specific comorbidities that worsen prognosis include chronic kidney disease, heart failure, arrhythmia, and cerebrovascular disease, all of which are more common in diabetic patients. 4

Realistic Prognosis Summary

For a 74-year-old with diabetes and newly diagnosed multiple myeloma:

• Best-case scenario (standard-risk disease, good performance status, optimal treatment): 5-7 years median survival is achievable. 2

• Most likely scenario (typical presentation, diabetes well-controlled): 3-4 years median survival with modern therapy. 1

• Worst-case scenario (high-risk cytogenetics, poor renal function, multiple comorbidities): 2-3 years or less. 1, 3, 4

The disease remains incurable, and nearly all patients eventually experience relapse, typically requiring four or more different lines of therapy throughout their disease course. 2