Improved survival in Medicare patients with multiple myeloma: findings from a large nationwide and population-based cohort

The aim of this study was to examine whether novel agents proteasome inhibitor bortezomib and immunomodulatory drugs lenalidomide and thalidomide are effective in prolonging overall survival (OS) for patients with newly diagnosed multiple myeloma (MM) in the real-world practice setting. A nationwide and population-based retrospective cohort of elderly patients with advanced newly diagnosed MM from 2000 to 2009 were identified from the Surveillance, Epidemiology, and End Results–Medicare linked data. Survival was compared between cases in 2005–2009 and in 2000–2004, and between patients treated with anti-MM therapy and the untreated among cases in 2005–2009, using Cox proportional hazards models, Kaplan–Meier methods, and propensity score adjustment to further control for baseline confounding. Of 8839 patients, 4028 (45.6%) cases were in 2000–2004 and 4811 (54.4%) in 2005–2009. OS was significantly longer for patients in 2005–2009 than patients in 2000–2004 (27.9 vs. 20.0 months, P < 0.001). The hazard ratio for OS for cases in 2005–2009 compared with those in 2000–2004 was 0.78 (95% CI 0.74–0.82). Among 4811 cases in 2005–2009, 54% (n = 2587) received anti-MM therapy. Compared to those untreated, OS was significantly longer (41.1 vs. 27.9 months, P < 0.001) and hazard ratio was 0.58 (95% CI 0.54–0.62) in the treated patients. This study demonstrated improved survival in newly diagnosed MM patients in a more recent 5-year cohort compared with those in the previous 5 years. The survival benefit was significant across different demographic and patient characteristics. However, there were still a substantial number of MM patients not receiving anti-MM therapy.