A few preliminary remarks:
2. The study considers only myeloma patients undergoing conventional treatments.
3. Specifically: “Patients with smouldering (asymptomatic) myeloma, amyloidosis and monoclonal IgM disorders were not included.”
The International Myeloma Working Group analysed 10,549 myeloma patients for this project. 17 institutions and study groups from North America, Japan and Europe participated in the study, which covers the period 1981-2002. Most of the patients were from Europe.
The authors “report the presenting features and outcome after conventional and high-dose therapy in 10,549 myeloma patients and compare the findings obtained in 1,689 patients less than 50 years of age with those of 8,860 older patients.” 70% of all the patients had participated in clinical trials (7,413 people). Stage of the disease was assessed using the International Staging System, or ISS (see: http://tinyurl.com/2ab8sw), and the Durie-Salmon system, see: http://tinyurl.com/ytcqe9
In particular, “High-dose chemotherapy with autologous stem cell transplantation resulted in a higher relative excess risk of death in the older patients (median survival 5.7 years) compared to the younger patients (7.5 years). Similarly, the observed 10-year survival rate was significantly higher in the younger patients (43% versus 29%, logrank P=.005). Relative survival was similar in the subgroup of patients aged 40 to <50 years versus that of very young patients, both after conventional chemotherapy (4.4 years versus 4.7 years) and after autologous transplantation (7.3 years versus 7.5 years) (relative excess risk estimate: 1.09 and 0.93, respectively). And 10-year survival rates were also similar, both after conventional (21% versus 19%, P=.37) and after high-dose treatment (44% versus 38%, P=.76, by log-rank test).”
Sorry about all these long quotes, but it’s difficult to summarize numbers!
And now we get to the final part of the study (I skipped a lot of the numbers, eh!), and, you guessed it, here is another long quote: “The most important finding in this study on 10,549 patients with multiple myeloma was the significant differences in the presenting features between young and older patients. Young patients presented with significantly lower ISS stage and consequently had less frequently elevation of ß2-microglobulin and reduction of low serum albumin levels. In addition, significantly fewer younger patients presented with poor performance status, anemia, renal impairment, or increased CRP levels. Older patients, in contrast had a greater prevalence of less favorable prognostic factors. Hence, both a lower ISS stage at diagnosis and overall better prognostic factors seem to account for the superior survival in young patients treated with high-dose therapy after correction for differences in life expectancies, with age remaining an independent risk factor for patients treated with conventional therapy.” Another finding was the low number of young patients: only 0,26% were younger than 30 years of age. Young age was associated with longer survival.
Even though, as stated above, I am wary of statistics and take them with a grain of salt, I admit that I would really like to read a similar statistical analysis concerning those of us following alternative treatments. Perhaps some day…who knows?