The Myeloma Landscape in Australia and New Zealand: The First 8 Years of the Myeloma and Related Diseases Registry (MRDR)

Krystal Bergin; Cameron Wellard; Elizabeth Moore; Zoe McQuilten; Hilary Blacklock; Simon J Harrison; P Joy Ho; Tracy King; Hang Quach; Peter Mollee; Patricia Walker; Erica Wood; Andrew Spencer; Australian and New Zealand Myeloma and Related Diseases Registry

doi:10.1016/j.clml.2021.01.016

The Myeloma Landscape in Australia and New Zealand: The First 8 Years of the Myeloma and Related Diseases Registry (MRDR)

Clin Lymphoma Myeloma Leuk. 2021 Jun;21(6):e510-e520. doi: 10.1016/j.clml.2021.01.016. Epub 2021 Jan 30.

Affiliations

¹ Department of Haematology, Alfred Health-Monash University, Melbourne, Victoria, Australia.
² School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
³ Clinical Haematology, Middlemore Hospital, Middlemore, Auckland, New Zealand.
⁴ Clinical Haematology, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Melbourne, Victoria, Australia; Clinical Haematology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁵ Royal Prince Alfred Hospital, Camperdown, and University of Sydney, Sydney, New South Wales, Australia.
⁶ Clinical Haematology, University of Melbourne and St Vincent's Hospital, Melbourne, Victoria, Australia.
⁷ Clinical Haematology, Princess Alexandra Hospital and University of Queensland, Brisbane, Queensland, Australia.
⁸ Clinical Haematology, Peninsula Health, Frankston, Victoria, Australia.
⁹ Department of Haematology, Alfred Health-Monash University, Melbourne, Victoria, Australia. Electronic address: andrew.spencer@monash.edu.

PMID: 33785297
DOI: 10.1016/j.clml.2021.01.016

Abstract

Background: Real-world multiple myeloma (MM) data are scarce, with most data originating from clinical trials. The Myeloma and Related Diseases Registry (MRDR) is a prospective clinical-quality registry of newly diagnosed cases of plasma cell disorders established in 2012 and operating at 44 sites in Australia and New Zealand as of April 2020.

Methods: We reviewed all patients enrolled onto the MRDR between June 2012 and April 2020. Baseline characteristics, treatment, and outcome data were reviewed for MM patients with comparisons made by chi-square tests (categorical variables) and rank sum tests (continuous variables). Kaplan-Meier analysis was used to estimate progression-free survival and overall survival (OS).

Results: As of April 2020, a total of 2405 MM patients were enrolled (median age, 67 years, with 40% aged > 70 years). High-risk features were present in 13% to 31% of patients: fluorescence in-situ hybridization (FISH) ≥ 1 of t(4;14), t(14;16), or del(17p) 18%, International Staging System (ISS)-3 31%, and Revised ISS (R-ISS)-3 13%. Cytogenetic/FISH analyses were performed in 50% and 68% of patients, respectively, with an abnormal karyotype result in 34%. Bortezomib-containing therapy was the most common first-line therapy (79.3%, n = 1706). Patients not receiving bortezomib were older (median age, 76 vs 65 years, P < .001) with inferior performance status (Eastern Cooperative Oncology Group performance status ≥ 2, 41% vs 18%, P < .001). Median progression-free survival and OS were 30.8 and 65.8 months, respectively. Younger patients had superior OS (76.3 vs 46.7 months, P < .001, < 70 and ≥ 70 years, respectively). R-ISS score was available in 50.7% (n = 1220) of patients, and higher R-ISS was associated with inferior OS (R-ISS-1 vs R-ISS-2 vs R-ISS-3: not reached vs 68.1 months vs 33.2 months, respectively, P < .001).

Conclusion: Clinical registries provide a more complete picture of MM diagnosis and treatment, and highlight the challenges of adhering to best practices in a real-world context.

Keywords: Autologous transplantation; Diagnosis; Multiple myeloma; Real world; Therapy.

MeSH terms

Aged
Aged, 80 and over
Australia / epidemiology
Clinical Decision-Making
Combined Modality Therapy
Comorbidity
Disease Susceptibility
Female
Humans
Male
Middle Aged
Monoclonal Gammopathy of Undetermined Significance / diagnosis
Monoclonal Gammopathy of Undetermined Significance / epidemiology
Monoclonal Gammopathy of Undetermined Significance / therapy
Multiple Myeloma / diagnosis
Multiple Myeloma / epidemiology*
Multiple Myeloma / etiology
Multiple Myeloma / therapy
New Zealand / epidemiology
Outcome Assessment, Health Care
Prognosis
Public Health Surveillance
Registries