Impact of age, sex, ethnicity, socio-economic deprivation and novel pharmaceuticals on the overall survival of patients with multiple myeloma in New Zealand.

The impact of age, ethnicity and socio-economic deprivation in the era of novel anti-myeloma agents is unclear. Using linked national data from New Zealand, we evaluated the incidence, prevalence and overall survival (OS) of individuals who were diagnosed with myeloma between 2004 and 2016. The crude incidence rate increased from 5·42 to 8·47/100 000 and the age-standardised rate increased from 4·01 to 5·28/100 000. The estimated prevalence in December 2016 was 37·8/100 000. Median OS increased from 34·8 (95% CI 31·4, 39·3) months in 2004-2007 to 50·7 (48·5, 57·3) months in 2012-2016. Following the public funding of bortezomib in 2011, the median OS for individuals >70 years increased from 19·4 (16·3, 23·1) to 28·6 (24·5, 32·8) months. For those ≤70 years of age who did not have autologous stem cell transplantation (ASCT), median OS increased from 49·1 (37·1, 57·5) to 62·7 (51·7, 79·2) months; but for those who had ASCT, there was no difference in median OS. Socio-economic deprivation was an independent adverse prognostic factor. Maori/Pasifika and those in the most deprived quintile experienced no improvement in survival after bortezomib was funded. Our study confirms the increasing incidence and improving survival of myeloma patients, and the negative impact of Maori/Pasifika ethnicity and socio-economic deprivation on survival.

Current Review on High-Risk Multiple Myeloma.

PURPOSE OF REVIEW: New risk stratification systems and treatment strategies have been introduced in recent years. We aim to provide an overview of these recent changes and summarise these data in a concise article that would be useful for clinicians. RECENT FINDINGS: Apart from clinical stage, disease genetics are now recognised as important prognostic risk factors, and various new cytogenetic changes with negative prognostic impact have been identified. New technologies such as minimal residual disease detection are also playing an important role in prognostic assessment. Recent introduction of combination therapy with proteasome inhibitors and immunomodulatory drugs is showing promising results in high-risk patients and may partially abrogate the negative impact associated with some of the adverse risk factors. Recent advance has improved our understanding of high-risk multiple myeloma, and new therapeutic agents are now coming through the pipeline for this patient group with once dismal outcome.