Study finds potential association between allostatic load and worse overall survival in MM
A recent study aimed to identify associations between socioeconomic status, allostatic load, and clinical trial endpoints in patients with multiple myeloma (MM).
Despite advances in the diagnosis and treatment of multiple myeloma (MM), social determinants of health (SDOH) remain influential on disease outcomes for patients with MM. A recent study published in Blood Cancer Journal aimed to provide insight into how patients’ neighborhood socioeconomic status (SES) and baseline allostatic load (AL) affect disease burden and outcomes.
SDOHs can be environmental, psychosocial, biological, or behavioral characteristics that affect general health and disease outcomes. In MM, patients living in areas with high poverty rates are known to have worse mortality rates than places with lower poverty rates, for example.
“The likely explanations for the influence of SDOH in patients with MM rely on a complex interplay between the availability of resources (e.g., access to health care), environmental exposures, adverse living conditions, genetics and psychosocial factors,” the study authors wrote.
AL is a score produced by measuring the cumulative effects that chronic stress can have on physiology, including morbidity and mortality. Overall, in cancer patients, AL has been associated with increased mortality.
The current study focused on multiple endpoints and was based on data from the open-label, randomized, Phase 3 ECOG-ACRIN E1A11 trial, which included 1087 symptomatic patients with a new diagnosis of MM: symptom burden at baseline and at 5.5 months, non-completion of induction therapy, overall survival and progression-free survival (PFS). Seven biomarkers were used to determine AL scores.
The study cohort included 933 patients with a median age of 65 years. The cohort had a median SES score of 53.7 (lower SES scores indicate greater neighborhood deprivation) and a median AL score of 2.
Overall, higher AL scores were associated with higher baseline fatigue and poorer OS. A one-unit increase in baseline AL produced a greater likelihood of high fatigue at baseline (adjusted odds ratio [OR], 1.21; 95% CI, 1.08-1.36). Regarding OS, the adjusted HR was 1.21 (95% CI, 1.06-1.37).
A high SES score was associated with greater discomfort at baseline, with an OR of 4.49 compared to low SES. Average nSES scores were associated with an OR of 4.22 relative to low SES. However, high fatigue or pain at baseline were not associated with SES levels.
Neither AL nor SES was associated with symptom burden at 5.5 months, treatment discontinuation, or PFS. And although AL can potentially be predictive of OS and help tailor treatment to each patient, SES was not associated with OS in this study.
The study results regarding the association of LA and SG in patients with MM are consistent with previous studies of LA in patients with other types of cancer. However, knowledge gaps remain as to exactly why AL is associated with poorer outcomes in cancer patients.
One limitation of the study was the limited availability of AL biomarkers in the overall clinical trial cohort, since AL was not an objective of the trial itself. Another limitation was the study population, as patients in clinical trials are often younger, wealthier, and have higher education. With a larger population, the effects may be greater.
Further research is needed to confirm that AL is a potential prognostic biomarker for OS, but overall the results of this study add to previous work suggesting that high baseline AL scores may affect outcomes for all types of cancer.
“The clinical significance of AL must be contextualized within a patient’s values and treatment goals,” the authors wrote. “For example, a patient with high AL may be interested in participating in psychosocial support services (eg, stress reduction) that would reduce their AL and increase overall survival. Specifically, the 20% increase in risk of death from any cause with each increase of one unit of LA may be a high enough threshold for them to consider risk reduction strategies. ‘AL. »
Obeng-Gyasi S, Graham N, Kumar S, et al. Review of allostatic load, neighborhood socioeconomic status, symptom burden, and mortality in patients with multiple myeloma. Blood cancer J. Published online April 1, 2022. doi:10.1038/s41408-022-00648-y