Hemminki, K., Zitricky, F., Försti, A. et al. Large differencies in age-specific survival in multiple myeloma in the nordic countries. Blood Cancer J. 14, 43 (2024). https://doi.org/10.1038/s41408-024-01026-6
A new research paper authored by the team of the Laboratory of Translation Cancer Genomics has recently been published:
Treatment of multiple myeloma (MM), like most hematological neoplasms, has developed fast and completely novel therapeutic modalities have been introduced [1]. In the late 1980s autologous stem cell transplantation (ASCT) was introduced in hematology, and for MM it was used in combination with high-dose melphalan treatment [2]. Eligibility for ASCT was considered by fitness of the patients and their age (<65 years), which however has been increased to 70 or 75 years [3]. In the Nordic countries some 30% of MM patients undergo this primary treatment [4, 5]. Vincristine, adriamycin, and dexamethasone were introduced as induction treatment. This was followed by about 2010 by agents based on novel mechanisms of action, including immunomodulatory agents (e.g., thalidomide, lenalidomide) and proteasome inhibitors (e.g., bortezomib), which transformed the management of MM [4–6]. Novel proteasome inhibitors and immunomodulatory agents have been introduced, and most recently immunotherapies have become available. Treatment of patients not eligible for ASCT diagnosed at age >75 years was compared in Sweden and Denmark up to year 2020 and found to be approximately similar [6]. Even though the disease was more advanced with higher ISS stage and with higher degree of renal impairment in the old patients, they responded and tolerated treatment.
Survival has improved in MM in Sweden and USA but survival in elderly patients has remained below that of younger patients [7–9]. As treatments, such as ASCT and extensive chemotherapeutic regiments, may be limited to or tolerated by the fit and young patients it is relevant to investigate the up-to date age-group specific survival which was recently enabled in the NORDCAN database, allowing an analysis through a half century up to year 2021 [10]. These results for 1-year and 5-year relative survival are presented here for Denmark (DK), Finland (FI), Norway (NO) and Sweden (SE), with methods shown in Supplement, and reasons for the country-specific differences are discussed.
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