Patients Factors & Impacts

Renal Impairment’s Effect on MM Patients

Although renal impairment is a common complication in patients with multiple myeloma these patients are often excluded from or underrepresented in clinical trials because of¹:

Restrictive renal exclusion criteria
Failure to collect data in renally impaired patients
Difficulty in translating results to real-world practice.

50% of patients with multiple myeloma have renal impairment and it forms a core part of the CRAB criteria used to diagnose multiple myeloma^2,3

C

calcium
(hypercalcemia)

R

Renal
impairment

A

Anemia

B

Bone
lesions

Underrepresentation Putting Patients at Risk⁴

<65

years

65-75

years

75+

years

How do you treat a patient population effectively that is underrepresented in clinical trials? While multiple myeloma is predominantly a disease of the elderly,⁵ there is still a reluctance to include elderly cancer patients in clinical trials because of reduced performance, comorbidities, and organ dysfunction.^6,7 That leaves this difficult-to-treat population with a lack of robust treatment guidelines.⁴

50 percent of elderly patients will need 3 or more GP visits before diagnosis, and this contributes to a 6-month delay in an average diagnosis of MM.⁶

Patients >65 years of age have worse survival rates than younger patients⁵

Characteristics commonly found in elderly patients make treatment difficult^4,8-10

Reduced fitness for treatment
Decreased resilience to treatment-related toxicity
Fraity
Difficulty of Diagnosis
Reduced treatment choices
Underrepresentation in clinical trials

The Relationship between Multiple Myeloma and Cytogenetic Abnormalities

The presence of high-risk cytogenetic features has been well documented as a negative prognostic factor and these patients typically have poorer outcomes compared with standard risk patients.^11,12

Patients with high-risk cytogenetics are not always captured in clinical trials or real-world studies, resulting in subgroup analyses on a relatively small sample size.^1,13,14 Because of this, it is important that these patients be encouraged to participate in randomized trials so more data can be collected.¹⁴

The presence of multiple cytogenetic abnormalities further decreases prognosis compared with individual high-risk abnormalities^11,13,15

There remains a detrimental gap between high-risk and standard-risk cytogenetic patients^14,16

With more than 130,000 new diagnoses of multiple myeloma a year globally, it's important to recognize the signs and symptomps of MM.

References

Richardson PG, San Miguel JF, Moreau P, et al. Interpreting clinical trial data in multiple myeloma: translating findings to the real-world setting.Blood Cancer J. 2018;8(11):109.
Faiman B, Doss D, Colson K, Mangan P, King T, Tariman JD. Renal, GI, and peripheral nerves: evidence-based recommendations for the management of symptoms and care for patients with multiple myeloma. Clin J Oncol Nurs. 2017;21(5 Suppl):19-36.
Raab MS, Cavo M, Delforge M, et al. Multiple myeloma: practice patterns across Europe.Br J Haematol. 2016;175(1)66-76.
Baijal P, Periyakoil V. Understanding frailty in cancer patients.Cancer J. 2014;20(5):358-366.
National Cancer Institute. Cancer stat facts: myeloma.https://seer.cancer.gov/statfacts/html/mulmy.html. Accessed March 2022.
Willan J, Eyre TA, Sharply F, Watson C, King AJ, Ramasamy K. Multiple myeloma in the very elderly patient: challenges and solutions.Clin Interv Aging. 2016;11:423–435.
Hutchins LF, Unger JM, Crowley JJ, Coltman CA, Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials.N Engl J Med. 1999;341(27):2061-2067.
Palumbo A, Bringhen S, Mateos M-V, et al. Geriatric assessment predicts survival and toxicities in elderly myeloma patients: an International Myeloma Working Group report.Blood. 2015;125(13):2068-2074.
Fried LP, Ferrucci L, Darer J, Williamson JF, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care.J Gerontol A Biol Sci Med Sci. 2004;59(3):255-263.
NCCN Guidelines: Multiple Myeloma Version 2.2019. https://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf. Accessed March 2021.
Sonneveld P, Avet-Loiseau H, Lonial S, et al. Treatment of multiple myeloma with high-risk cytogenetics: a consensus of the International Myeloma Working Group.Blood. 2016;127(24):2955-2962.
Nooka AK, Lonial S. New targets and new agents in high-risk multiple myeloma.Am Soc Clin Oncol Educ Book. 2016;35:e431-e441.
Jian Y, Chen X, Zhou H, et al. Prognostic impact of cytogenic abnormalities in multiple myeloma: a retrospective analysis of 229 patients.Medicine (Baltimore). 2016;95(19):e3521.
Lancman G, Tremblay D, Barley K, et al. The effect of novel therapies in high-molecular-risk multiple myeloma.Clin Adv Hematol Oncol. 2017;15(11):870-879.
Boyd KD, Ross FM, Chiecchio L, et al; NCRI Haematology Oncology Studies Group. A novel prognostic model in myeloma based on co-segregating adverse FISH lesions and the ISS: analysis of patients treated in the MRC Myeloma IX trial.Leukemia. 2012;26(2):349-355.
Kumar S, Fonseca R, Ketterling RP, et al. Trisomies in multiple myeloma: impact on survival in patients with high-risk cytogenetics.Blood. 2012;119(9):2100-2105.