Improved survival outcomes and relative youthfulness of multiple myeloma patients with t(4;14) receiving novel agents are associated with poorer performance of the revised international staging system in a real aging society
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Yoshiaki Abe1, Kazutaka Sunami2, Takeshi Yamashita3, Mikio Ueda3, Hiroyuki Takamatsu4, Kentaro Narita1, Hiroki Kobayashi1, Akihiro Kitadate1, Masami Takeuchi1 and Kosei Matsue1
1Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Chiba, Japan
2Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
3Department of Internal Medicine, Keiju Kanazawa Hospital, Ishikawa, Japan
4Department of Hematology/Respiratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
Yoshiaki Abe, email: firstname.lastname@example.org
Keywords: aging; multiple myeloma; prognosis; revised international staging system; t(4;14)
Received: October 06, 2018 Accepted: December 27, 2018 Published: January 15, 2019
The Revised International Staging System (R-ISS) was developed for a more accurate risk stratification of patients with symptomatic multiple myeloma (MM). However, original and subsequent validation studies of the R-ISS included relatively younger patients, many of whom were treated without bortezomib. Hence, we investigated the real-world prognostic performance of the R-ISS in 400 patients with MM treated with novel agents in Japan, an aging society. The patients had a median age of 72 years, and 96.0% were treated with bortezomib. Patients in R-ISS stage II were significantly older and failed to show significantly longer overall survival (OS) compared to patients in R-ISS stages III (median age; 74 and 70 years, respectively; P = 0.001, and median OS; 63.4 vs. 54.7 months, respectively; P = 0.32). However, OS differed significantly among patients with all conventional ISS stages. ISS stage III patients recategorized to R-ISS stage III were significantly younger than those recategorized to R-ISS stage II and had a relatively longer OS. As a reason for these findings, patients with the high-risk cytogenetic abnormality t(4;14) were significantly younger and had an improved OS compared to others, which can be attributed to a young age and bortezomib therapy, as previously suggested. In conclusion, the R-ISS was less successful than the ISS in discriminating between stages II and III among bortezomib-treated patients with MM in an aging society, which might be attributable to the inclusion of t(4;14) in the R-ISS categorization strategy.
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