Women with Multiple Myeloma More Likely to Have High-Risk Cytogenetics

A study found sex differences in high-risk cytogenetics among patients with multiple myeloma (MM), though these differences did not carry over to clinical outcomes.

These findings were published in Clinical Lymphoma, Myeloma, & Leukemia.

The researchers evaluated the association between sex and disease presentation and outcomes in 3894 patients enrolled in the phase III Myeloma XI trial. The study cohort comprised 58% male and 42% female patients and included transplant-eligible and transplant ineligible patients.

There were significant differences in hemoglobin, platelet count, and renal function between the sexes. Female patients had a small but statistically significant difference in bone marrow plasma cell percentage at baseline, “suggesting a higher level of disease burden in females,” wrote the authors. There were no differences between sexes in International Staging System disease stage at baseline or after treatment.

The team used molecular data from a subset of 1610 patients to identify averse cytogenetic lesions on myeloma cells, defined as t(4;14), t(14;16), t(14;20), del(17p) and gain(1q). Female patients had higher rates than men in t(14;16) (4.2% vs. 1.8%; P = 0.004) and del(17p) (10.6% vs. 7.4%; P = 0.023). In addition, female patients were also more likely to have high-risk or ultra-high-risk MM than men (P = 0.026). Rates of high-risk disease were 35% and 33% among females and males, respectively. Thirteen percent of female patients had ultra-high-risk disease, compared with 9.8% of men.

Overall response to treatment was similar between sexes across randomizations. The overall response rate was 82.1% in males versus 80.3% in females, and the rate of very good partial responses was 54.4% and 51.0%, respectively. Overall survival and progression-free survival did not differ significantly between groups, even when stratified across various randomization subgroups.

“Females were more likely to have the cytogenetic risk lesions t(14;16) and del(17p) and more HiR and UHiR disease,” wrote the authors in their conclusion. “This was not associated with reduced progression-free survival and overall, and therefore treatment in the context of the Myeloma XI trial, might have been able to overcome some of the adverse effects of the risk lesions present.”

Reference

Bird S, Cairns D, Menzies T, et al. Sex Differences in Multiple Myeloma Biology but not Clinical Outcomes: Results from 3894 Patients in the Myeloma XI Trial. Clin Lymphoma Myeloma Leuk. 2021 Oct;21(10):667-675.