Sex-Disaggregated Analysis of Biology, Treatment Tolerability, and Outcome of Multiple Myeloma in a German Cohort

Abstract

<b><i>Introduction:</i></b> Multiple myeloma (MM) is a plasma cell disease that affects more men than women. Although there is an obvious imbalance in incidence, knowledge of differences in biology and outcome between the sexes is surprisingly rare. <b><i>Methods:</i></b> We performed a unicentric retrospective analysis of patients with MM treated at a tertiary cancer centre between 2003 and 2018. <b><i>Results:</i></b> We present a sex-disaggregated analysis of the characteristics and outcome of MM in a cohort of 655 patients (median age at diagnosis 62 years; 363 men with a median age at diagnosis 62 years and 292 women with a median age at diagnosis 63 years, <i>p</i> = 0.086). Most patients (<i>n</i> = 561, 86%) received myeloma-specific treatment. Median overall survival was 76 months (95% CI 63–89) (72 months in men [95% CI 54–90] and 83 months in women [95% CI 66–100], <i>p</i> = ns). Apart from a higher incidence of moderate and severe anaemia in women (<i>p</i> &#x3c; 0.001), there were no statistically significant differences in the biology of the underlying MM. Similarly, in the group of patients who received high-dose therapy with autologous stem-cell transplantation (ASCT, <i>n</i> = 313), no statistically significant differences apart from more frequent anaemia in women were detected regarding the biology of the disease. However, there was a trend toward a higher plasma cell infiltration of the bone marrow and toward more frequent high-risk features in women. In contrast, relevant comorbidities were significantly more common in men (for example, coronary heart disease in 13% of men vs. 2% of women, <i>p</i> &#x3c; 0.001). Toxicities after ASCT were not significantly different between the sexes with the exception of severe mucositis, which occurred in 22% of men versus 40% of women (<i>p</i> = 0.001). <b><i>Conclusion:</i></b> In conclusion, this first sex-disaggregated analysis of MM patients in Germany supports previous findings that survival is comparable amongst sexes, but women experience more toxicity of high-dose therapy. The higher incidence of clinically relevant anaemia in women warrants further investigation to exclude underlying treatable causes.