Clinical Scorecard: Systematic Evaluation of Mortality Causes in Patients with Multiple Myeloma
At a Glance
Category
Detail
Condition
Multiple Myeloma (MM), a hematological malignancy with clonal expansion of bone-marrow plasma cells
Key Mechanisms
MM progression, therapy-related complications including acute toxicity, immunosuppression-related infections, and second primary malignancies (SPM)
Target Population
Patients diagnosed with Multiple Myeloma undergoing therapy
Care Setting
Hematology/Oncology clinical trials and registry settings in Germany
Key Highlights
Among 617 MM patients who died, 83% of deaths were MM-dependent: 50% MM-progression-related, 19% therapy-related, and 13% not attributable to progression or therapy.
Therapy-related deaths peaked early after therapy start and increased notably during the COVID-19 pandemic, with infections (including COVID-19) as leading causes.
Second primary malignancies, especially hematological neoplasms like AML and MDS, contributed increasingly to therapy-related deaths with longer survival.
Guideline-Based Recommendations
Diagnosis
Classify cause of death (COD) in MM patients into MM-dependent (progression-related, therapy-related, other), MM-independent, or unknown categories using clinical and MedDRA SOC terms.
Management
Monitor for therapy-associated complications including infections and second primary malignancies throughout treatment and follow-up.
Implement infection prevention strategies, especially during periods of immunosuppression and pandemics.
Consider risks of therapy-related hematological malignancies in long-term survivors.
Monitoring & Follow-up
Prospectively assess COD and survival trajectories to identify patterns and inform clinical decision-making.
Use survival analysis and competing risk models to evaluate impact of COD categories on patient outcomes.
Risks
Therapy-related infections significantly increase mortality risk, particularly during pandemics.
Second primary malignancies, especially AML and MDS, pose increasing mortality risk with longer survival.
MM progression remains the leading cause of death, especially within the first six months of therapy.
Patient & Prescribing Data
MM patients enrolled in GMMG-HD6, GMMG-HD7 clinical trials and Heidelberg-MM-registry
Therapy-related mortality is highest early after treatment initiation and influenced by infectious complications; survival improved until 2019 but declined during COVID-19 pandemic due to increased therapy-related infections.
Clinical Best Practices
Employ standardized COD classification systems integrating MM-dependence and MedDRA SOC terms for accurate mortality assessment.
Vigilantly monitor and manage infectious complications during and after MM therapy, with heightened awareness during pandemics.
Screen for and manage second primary malignancies, particularly hematological neoplasms, in long-term MM survivors.
Use survival and hazard modeling to guide individualized patient risk stratification and therapy adjustments.
by Jia xiang Jin, Britta Besemer, Büsranur Yilmaz, Mathias Hänel, Roland Fenk, Uta Bertsch, Kaarina-Jiayuan Gu, Christine Hanoun, Igor W. Blau, Christoph Mann, Christof Scheid, Roland Schroers, Ivana von Metzler, Manfred Hensel, Eva-Maria Klein, Martin Hoffmann, Christoph Lutz, Hendrik Riesenberg, Uwe M. Martens, Christian S. Michel, Christian Kunz, Evgenii Shumilov, Deniz Gezer, Tobias A. W. Holderried, Karolin Trautmann-Grill, Carsten Müller-Tidow, Katja C. Weisel, Marc S. Raab, Hans J. Salwender, Hartmut Goldschmidt, Elias K. Mai
