Presenting Characteristics and Symptom Burden of Newly Diagnosed Older Multiple Myeloma Patients in the Commpass Study
Authors: Keller Jesse , Fiala Mark A , Slade Michael , Stockerl-Goldstein Keith , Tomasson Michael , Wildes Tanya M , Vij Ravi 
Published: October 2019

Abstract
Background: Multiple myeloma (MM) is a disease of older adults, with a median age of diagnosis in the late 60s. While treatment advances have prolonged overall survival (OS) in MM, improvements have been modest among older MM patients. Symptom burden and quality of life are concerns for older patients, as they are more susceptible to treatment intolerance and dose reduction or treatment cessation. Older patients are often under-represented in clinical trials, and less information is available regarding their presenting clinical characteristics and treatment course.
The Multiple Myeloma Research Foundation (MMRF) CoMMpass study, is a multicenter study in newly diagnosed multiple myeloma. It collects clinical-molecular data and patient reported health-related quality of life measures (EORTC QLQ-C30 and EORTC QLQ-MY20). In this study, we analyzed data from the CoMMpass study and compared presenting clinical characteristics, symptom burden and genetic features of newly diagnosed MM patients ≥ 75 years of age and those < 75 years of age. An additional analysis of t(4;14) was performed among those aged <65 years, 65-75 years and > 75 years to confirm prior observations that the incidence of t(4;14) decreases with age (Avet-Loiseau et al. 2013).
Methods: Clinical data from the interim analysis 6 of the CoMMpass study was extracted via the MMRF Researcher Gateway. CoMMpass eligibility requirements include: symptomatic MM with measureable disease by SPEP (≥1.0g/dL), UPEP (≥200mg/24 hours), or SFLC (≥10mg/dL); receiving an immunomodulator and/or a proteasome inhibitor for initial MM treatment; and no prior malignancies in the past 5 years.Enrollment began in July 2011. Clinical data is recorded at enrolling centers by data analysts. Analysis was with STATA 12.0. Categorical variables were compared withχ2; continuous variables were compared with student's t-tests and Wilcoxon rank-sum tests.
Results: 625 patients were eligible for analysis. 92 patients were ≥ 75 years of age, and 533 were < 75 years of age. Median ages were 80 years (range 75-93) and 63 years (range 27-74). Distribution of sex and race were evenly divided. Older patients had higher rates of International staging system (ISS), stage III disease at presentation. Baseline measurements of creatinine, platelet counts and hemoglobin were worse for older patients. On symptom and quality of life assessment, older patients were more likely to have difficulties with physical functioning, and were less likely to have difficulties with emotional functioning or finances. Subset analysis of those aged < 65 years, 65-75 years and > 75 years showed a trend towards decreasing rates of t(4;14).Results are summarized in Table 1.
Conclusion: Older patients in this study had higher ISS stage at diagnosis and worse ECOG performance status scores. Baseline labs showed inferior renal function and lower platelet and hemoglobin levels. Emotional and financial status was rated higher than younger patients, while physical functioning was worse. A trend towards decreased incidence of t(4;14) was appreciated by age.
Table 1. Clinical Characteristics ≥ 75 years (n=92) < 75 years (n=533) P Demographics Median age in years 80 63 Sex % NS Male 63 60 Female 37 40 Race % NS White 81 79 Black 19 18 Other 0 3 Heavy Chain % NS IgG 83 77 IgA 17 23 Light Chain % NS Kappa 65 62 Lambda 33 37 Biclonal 2 1 Disease Burden ISS Stage % <0.001 I 16 37 II 32 36 III 52 27 Serum M-Protein g/dL 2.96 2.8 NS Bone Marrow % Plasma Cells 9.6 8.6 NS Calcium mmol/L 2.35 2.35 NS Creatinine μmol/L 114.9 91.1 0.003 Hgb mmol/L 6.1 6.6 0.046 Platelets x109/L 191.5 216 0.001 LDH μkat/L 2.65 2.81 NS Health-Related Symptoms/Quality of Life Measures ECOG (%) 0.002 0 23 41 1 52 47 2 14 8 3-4 11 4 Global Health Scale 55.6 58.9 NS Physical Functioning Scale 62.4 71.3 0.009 Social Functioning Scale 68.8 68.6 NS Role Functioning Scale 58 60.6 NS Emotional Functioning Scale 80.2 71.9 0.003 Cognitive Functioning Scale 77.2 80.9 NS Financial Difficulties Scale 14.4 23.8 0.01 Fatigue Scale 40.3 38.2 NS Pain Scale 39.3 41.1 NS Molecular Characteristics (% of Patients) Abnormal Cytogenetics 41 43 NS del 13 31 29 NS del 17 19 19 NS t(11;14) 14.3 19.7 NS t(4;14) 7 10.3 NS Subset Analysis of t(4;14) >75 years 65-75 years <65 years P t(4;14) (% of patients) 5 7 13 0.053 Median presented unless specified

Disclosures
Vij: Takeda, Onyx: Research Funding; Celgene, Onyx, Takeda, Novartis, BMS, Sanofi, Janssen, Merck: Consultancy.