Summary
In a new analysis of a retrospective survey conducted annually between 2006 and 2015, researchers sought to better characterize utilization of stem cell transplantation (SCT) for patients with multiple myeloma at Worldwide Network for Blood & Marrow Transplantation regions around the globe.
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Original Article
The Global State of HSCT & Disease Burden for Patients With Multiple Myeloma
Oncology Times
Chuck Holt
In a new analysis of a retrospective survey conducted annually between 2006 and 2015, researchers sought to better characterize utilization of stem cell transplantation (SCT) for patients with multiple myeloma at Worldwide Network for Blood & Marrow Transplantation regions around the globe.
According to the researchers, incident rates of multiple myeloma, a clonal plasma cell neoplasm characterized by destructive bony lesions, anemia, and renal impairment increased 126 percent between 1990 and 2016 with an incidence rate of 2.1 of every 100,000 persons worldwide. Unfortunately, access to the most effective treatments developed over the past quarter century, including proteasome inhibitors, immunomodulatory agents, and autologous hematopoietic SCT (HSCT), has remained limited to wealthier countries with high-income sociodemographic index, according to the researchers. Results from the new analysis were revealed at the 2019 ASH Annual Meeting (Abstract 412)
Study Details
In the study, Cowan and other researchers found autologous HSCT performed worldwide for MM increased by 107 percent between 2006 and 2015. Activity increased during the same period were 56 percent in the U.S. and Canada, compared to 335 percent in Latin America. Utilization of autologous HSCT was highest in the Northern American and European WB regions, with an increase from 13 percent to 24 percent and 15 percent to 22 percent, respectively.
In contrast, utilization of autologous HSCT was much lower in the Africa/Mediterranean and Asian/Pacific region, increasing from 1.8 percent in 2006 to 4 percent in 2015, despite increased activity. The number of first allogeneic HSCT performed globally for multiple myeloma, meanwhile, declined since 2006, mostly in North America, and remained highest in the European WB region where it increased 8 percent.
In an interview with Oncology Times, ASH presenter and lead author of the study, Andrew J. Cowan, MD, a physician with the Seattle Cancer Care Alliance and Assistant Professor at the University of Washington School of Medicine, shared some of the key takeaways and other insights from results of the analysis.
What was the motivation for conducting your study?
We published last year in JAMA Oncology, a report on the global burden of multiple myeloma (2018;4(9):1221-1227). In our research, we described that both transplant utilization, and availability of novel agents (in this case, bortezomib and lenalidomide) are limited on a global level. Even in the era of improved induction therapy for multiple myeloma, autologous stem cell transplantation after induction remains a standard of care, I would argue, globally.
To better characterize the use of autologous and allogeneic stem cell transplantation, I collaborated with the Worldwide Network for Blood & Marrow Transplantation to look more closely at hematopoietic cell transplantation for multiple myeloma by region, from 2006 to 2015. We hypothesized that, as has been shown for stem cell transplant in general, the utilization of stem cell transplants would be greatest amongst high-income countries, but less well-utilized amongst low-middle income countries.
What are the key takeaways from the study that you will be sharing at ASH?
We found that overall, there has been a global increase in autologous stem cell transplantation for multiple myeloma, and this trend was seen in all the world regions we examined. However, utilization rates of autologous transplantation for multiple myeloma remain much higher in high-income regions such as Europe and North America, but dramatically lower in Asia-Pacific and Africa. The trend towards increased utilization, however, even amongst African and Latin America, is encouraging that more patients are getting access to this important therapy for multiple myeloma. Interestingly, if we look at the under-70 age group, autologous stem transplantation is very highly utilized in North America and Europe, in excess of 50 percent and 45 percent, respectively.
Did anything about the study findings surprise you?
We were somewhat surprised to learn that allogeneic stem cell transplantation has remained utilized at a steady rate in Europe (between 1-2% of all myeloma patients annually), yet has fallen off dramatically in North America, currently, to less than 0.39 percent of patients in 2015. We think that conflicting clinical trial results and the better availability of new drugs for multiple myeloma has probably contributed to this trend.
What, if any, are the potential clinical implications of your research?
I think our findings, importantly, show that more work is needed to improve access to, and utilization of, ASCT for multiple myeloma across the globe. This includes efforts to increase the number of transplant teams in different countries and regions where they are currently lacking, and increasing education of health care professionals worldwide about ASCT for multiple myeloma.
What further research needs to be conducted on this topic?
I think, not only do we need to figure out how to improve access to stem cell transplant services globally for multiple myeloma, we also need to determine the availability of new drugs that have changed outcomes for multiple myeloma patients—lenalidomide, bortezomib, carfilzomib, thalidomide, daratumumab, elotuzumab, amongst many. We should try not only to look at governmental approval, but also utilization of drugs, which could be measured in different ways.
Chuck Holt is a contributing writer.