There exists a higher rate of multiple myeloma (MM) progression in younger patients with smoldering multiple myeloma (SMM) patients than old ones as well as an earlier age of SMM diagnosis in Black patients compared to White patients, according to a study presented at the 17th International Myeloma Workshop.
SMM is the asymptomatic phase before MM, and until recently observation has been the standard protocol of care. However, enhancements in risk assessment and chemoprevention strategies is starting to yield enhanced early detection results.
In this study, researchers sought to characterize the demographics and dynamics of SMM patients. They analyzed data from the National Cancer Data Base (NCDB) between the year 2010 and 2014, and identified 68,234 patients, of which 11,643 had SMM (52% male, 71% white, 24% black). SMM was defined as patients that were placed on active surveillance or did not receive therapy in the first three months following diagnosis. They estimated the impact of medical insurance on overall survival using the Cox model, adjusting for confounders such as age, sex, race, tumor, and Charlson score.
According to the results, SMM was diagnosed in Blacks at an average age of 66, four years earlier compared to Whites, with an overall rate of progression of 21%. Subsequent to controlling for insurance, age and transplant effects, race was deemed insignificant in predicting the time from diagnosis of SMM to first therapy. Moreover, the study found that younger patients were more likely to receive therapy first. Researchers further observed that survival after starting therapy in SMM patients who progressed to MM was same for both races, but overall survival was higher in patients with private insurance plans.
The authors wrote that their findings highlight “the importance of known SMM stage before MM in prolonging survival which can be indicative of benefit from screening programs.”
Vuyyala S, et al. Risk of Progression Across Age and Race for Patients with Smoldering Multiple Myeloma. Presented at the 17th International Myeloma Workshop; September 12-15, 2019; Boston, MA.