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Transplant Cell Ther. 2021 Jun 18:S2666-6367(21)00998-2. doi: 10.1016/j.jtct.2021.06.014. Online ahead of print.
BACKGROUND: Therapeutic practices for multiple myeloma (MM) have evolved, such that novel-agent-based therapy and autologous peripheral blood stem cell transplantation (aPBSCT) is the current standard. Whether cause-specific mortality has changed with time remains unclear.
OBJECTIVE: we examined late cause-specific mortality among patients with MM receiving aPBSCT from 1989-2014.
STUDY DESIGN: We conducted a prospective cohort study using participants enrolled in the enrolled in the Blood or Marrow Transplant Survivor Study. We created three eras to reflect changing MM therapy: <2000 (pre-thalidomide); 2000-2005 (thalidomide); 2006-2014 (lenalidomide). We used Kaplan-Meier techniques and Cox regression for examining all-cause mortality, and sub-distribution hazards models for cause-specific mortality.
RESULTS: 1906 patients were followed for a median of 9.2y. Conditional on surviving 2y, the 10y-overall survival was 45%. The 10y cumulative incidence of myeloma- and non-myeloma-related mortality was 33% and 13% respectively. Multivariable analysis showed declining MM-specific mortality (sub-distribution hazard ratio [SHR]2000-2005=0.80, 95%CI, 0.60-1.07;: SHR2006-2014=0.46, 95%CI, 0.34-0.62; referent group: <2000), infection-related mortality (SHR2000-2005=0.50, 95%CI, 0.29-0.85; SHR2006-2014=0.35, 95%CI 0.21-0.60; referent group: <2000) and CVD-related mortality (SHR2000-2005=0.45, 95%CI 0.20-0.99; SHR2006-2014=0.41, 95%CI 0.18-0.93; referent group: <2000).
CONCLUSION: While primary disease remains the major cause of late mortality, we observed a significant temporal decline in myeloma-, infection- and cardiac-related late mortality over past 25y.