Army Maj. Alexander Dew, DO, MS, spoke at last year’s three-day, Convergent Science Virtual Cancer Center Second Annual Symposium at Walter Reed National Military Medical Center. Walter Reed photo
BETHESDA, MD — Military Health System (MHS) beneficiaries with multiple myeloma have longer 5- and 10-year survival rates compared to multiple myeloma patients from the U.S. general population, according to a recent study.
The study published in the journal Clinical Lymphoma Myeloma and Leukemia
compared multiple myeloma survival of MHS beneficiaries, which includes active-duty servicemembers, National Guard and Reserve members, retirees and their dependents, with multiple myeloma patients from the U.S. general population.1
The study authors are affiliated with Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences and the Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., all in Bethesda, MD.
The authors wanted to compare multiple myeloma survival in MHS beneficiaries vs. the U.S. general population, because their past studies have shown a survival benefit for MHS beneficiaries across multiple solid tumor malignancies, explained Alexander Dew, DO, MS, staff physician of hematology/oncology and director of the Hematopoietic Stem Cell Transplant Program at Walter Reed National Military Medical Center and assistant professor of medicine at Uniformed Services University of the Health Sciences.
“Given multiple myeloma is incurable, the second-most-common hematologic malignancy and common among MHS beneficiaries, it was important to study the survival impact of the MHS on this malignancy,” Dew told U.S. Medicine.
In this study, the researchers used the DoD’s Automated Central Tumor Registry (ACTUR) and the Surveillance, Epidemiology and End Results (SEER) databases to find data for multiple myeloma patients from MHS and the U.S. general population, respectively. Patients included in the study had histologically confirmed multiple myeloma between 1987 and 2013 and were followed through 2015 for overall survival. Two SEER patients were matched to each ACTUR patient by age group, sex, race and diagnosis-year group, which resulted in 1,488 patients from ACTUR and 2,976 matched patients from SEER being included in the study. Five- and 10-year survival were compared between ACTUR and SEER patients, the authors explained.
“Our study found that MHS beneficiaries with multiple myeloma had longer 5- and 10-year overall survival compared to multiple myeloma patients from the U.S. general population, regardless of age, sex or race. In fact, Black MHS beneficiaries showed better survival than white MHS beneficiaries when compared to the U.S. general population,” he pointed out.
“I think the main reason these differences were seen comes down to access to care,” Dew added. “If barriers to access are removed, as seen in the MHS, you see improvements in survival. Additionally, given MHS beneficiaries have minimal or no co-pays for prescription drugs, it makes sense that patients would stay on maintenance therapies (treatment given after induction therapy at a lower intensity until progression) longer, which have been shown to improve survival in patients with multiple myeloma.”
MHS provides universal healthcare to beneficiaries, and the researchers reported this universal care may lead to early detection of multiple myeloma and thus longer survival.
Previous studies have demonstrated that uninsured and Medicaid patients with multiple myeloma in the U.S. general population had worse survival than patients with private insurance. Also, patients who lived in neighborhoods with low socioeconomic status had higher multiple myeloma-specific death than those in high socioeconomic status neighborhoods. In addition, these studies discovered that non-Hispanic Black patients continued to have worse survival than non-Hispanic White patients, the researchers pointed out.
In the current study, the investigators found that median survival of ACTUR patients was 47.1 months, compared to 33.0 months of the SEER patients. Five- and 10-year death rates were significantly lower for ACTUR patients than the SEER patients, with an adjusted hazard ratio of 0.74 and 0.79. In addition, the survival advantage of ACTUR patients was maintained when stratified by age, sex, race and diagnosis year.
For healthcare professionals who are treating patients with multiple myeloma, Dew recommended clinical trial enrollment.
“There have been dramatic improvements in survival for patients with multiple myeloma over the past two decades with the incorporation of effective novel therapies, and I expect this trend to continue with the exciting treatments, such as CAR-T and bispecific antibodies, now being used,” he advised. “Maintenance therapy continues to be a key component in the treatment paradigm for patients with multiple myeloma. Future and ongoing studies are looking into different aspects of maintenance therapy, such as minimal residual disease (MRD), to understand if and when treatment can be discontinued or modified, and what disease specific factors may influence these treatment decisions.”
“As further understanding of the genomic and proteomic drivers of underlying multiple myeloma disease biology are better elucidated, I expect outcomes for patients with multiple myeloma to continue to improve, but this only occurs with clinical trial enrollment,” Dew added.
In the future, further studies are needed to explain specific factors related to patients, providers, patient-provider communications and the medical system that could contribute to the improved survival of MHS beneficiaries with multiple myeloma, according to the researchers.
- Dew A, Lin J, Darmon S, Roswarski J, Shriver C, Zhu K, Chiu A. Survival Among Patients With Multiple Myeloma in the United States Military Health System Compared to the Surveillance, Epidemiology, and End Results (SEER) Program. Clin Lymphoma Myeloma Leuk. 2024 Nov;24(11):789-795. doi: 10.1016/j.clml.2024.06.008. Epub 2024 Jul 2. PMID: 39034205.
