Allostatic load tied to survival in multiple myeloma

In patients with multiple myeloma (MM), a higher allostatic load (AL) seems to be an important predictor of worse overall survival (OS), a recent study has found.

The present analysis drew from ECOG-ACRIN E1A11, a multicentre, open-label, phase III randomized controlled trial that compared the efficacy of bortezomib, lenalidomide, and dexamethasone vs carfilzomib, lenalidomide, and dexamethasone. A total of 933 patients (mean age 64.1 years, 58.5 percent men) were eligible for the current assessment of AL score, which was calculated as a composite of seven biomarkers.

Multivariable logistic regression analysis revealed that a 1-unit increase in baseline AL significantly correlated with a higher likelihood of baseline fatigue (odds ratio, 1.14, 95 percent confidence interval [CI], 1.01–1.30). No such interaction was reported for pain, bother, or neighbourhood socioeconomic status.

Moreover, increasing AL was significantly associated with worse OS (log-rank p<0.0001) and progression-free survival (PFS; log-rank p=0.0003).

Adjusted Cox regression analysis further showed that for every 1-unit increase in AL, the risk of OS jumped by 20 percent (hazard ratio [HR], 1.20, 95 percent CI, 1.06–1.37). In contrast, the link between AL and PFS was attenuated in this analysis (HR, 1.08, 95 percent CI, 0.99–1.18).

“Our study adds to this existing work and confirms that elevated AL at baseline has implications for clinical outcomes such as survival among multiple myeloma patients,” the researchers said.

“Furthermore, we believe this study has laid the foundations for AL to be considered as a possible prognostic biomarker in conjunction with established prognostic markers and imaging, for overall survival in patients with MM,” they added.