A clinical Analysis of CoMMpass Multiple Myeloma sites by patient accrual
Multiple myeloma (MM) is a hematological malignancy that is currently treatable, but not curable. Due to its clinical and genetic heterogeneity, a generalized effective treatment regimen has not yet been established. The Multiple Myeloma Research Foundation CoMMpass study is a 10-year, observational clinical study that generates clinical and molecular data for 1143 MM patients in the United States, Canada, Spain, and Italy. While sequencing data can help unravel the genetic basis of MM, clinical data analysis can provide insight into treatment outcomes across the cohort or at individual clinical sites. For this analysis, North American sites participating in the CoMMpass study were subset based on patient accrual. Initial analyses of high versus low-accruing sites revealed that patients at high-accruing sites had better median overall and progression-free survival than patients at low-accruing sites despite having similar demographics, including gender, age, and ethnicity distributions. One notable difference was that low-accruing sites had a lower transplant rate than high-accruing sites. We then individually analyzed each high-accruing MM site to determine which factors were primarily influencing the differences in survival observed between the two groups. Analysis of the seven individual high-accruing sites revealed a surprising difference between treatment regimens, despite similar demographics and survival outcomes. We found that the two high-accruing sites with the best survival outcomes used vastly different treatment regimens: one site had a high transplant rate and used a standard induction treatment (bortezomib/lenalidomide/dexamethasone) in 75% of their patients, whereas the other site had a low transplant rate (25% of patients) and patients were uniformly prescribed carfilzomib. This is an interesting finding because it has previously been shown that patients who receive transplants tend to have better survival outcomes. Analyzing how treatment strategies at individual clinical sites influence patient outcomes can provide further insight into the discussion surrounding the efficacy of different treatment regimens, including the use of transplants, in MM patients.