Agbuduwe, Charles;
Iqbal, Gulnaz;
Cairns, David A;
Menzies, Tom;
Dunn, Janet;
Gregory, Walter Martin;
Kaiser, Martin F;
... Basu, Supratik; + view all
(2022)
Clinical Characteristics and Outcomes of IgD Myeloma: Experience across UK National Trials.
Blood Advances
10.1182/bloodadvances.2022007608.
(In press).
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Abstract
IgD myeloma is a subtype often considered to have adverse features and inferior survival but there is a paucity of data from large clinical studies. We compare the clinical characteristics and outcomes of IgD myeloma patients from UK Phase III myeloma trials analysed in two groups; old (1980-2002) and recent (2002-2016) clinical trials, based on the time of adoption of novel myeloma therapies. IgD myeloma patients comprised 44/2789 (1.6%) and 70/5773 (1.2%) of the old and recent trials respectively. Overall, IgD myeloma was associated with male predominance, low-level paraproteinemia (<10g/l) and lambda light chain preference. The frequency of ultra-high risk cytogenetics was similar in IgD myeloma compared with other subtypes (4.3% vs 5.3%, p>0.99). Despite the old trial series being a younger group (median age: 59 years vs 63 years, p=0.015), there was a higher frequency of bone lesions, advanced stage at diagnosis, worse performance status and severe renal impairment compared with the recent trials. Furthermore, the early mortality rate was significantly higher for the old trial series (20% vs 4%, p=0.01). The overall response rate following induction therapy was significantly higher in the recent trials (89% vs 43%, p<0.0001) and this was consistent with improved median overall survival (48 months; 95% CI 35-67 months vs 22 months, 95% CI 16-29 months). Survival outcomes for IgD myeloma have significantly improved and are now comparable to other myeloma types due to earlier diagnosis, novel therapies and improved supportive care. (Myeloma IX International Standard Randomised Controlled Trial Number: 68454111, Myeloma XI International Standard Randomised Controlled Trial Number: 49407852).
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