Study Finds Potential Association Between Allostatic Load, Worse Overall Survival in MM

Despite advances in the diagnosis and treatment of multiple myeloma (MM), social determinants of health (SDOH) remain influential in disease outcomes for patients with MM patients. A recent study published in Blood Cancer Journal aimed to provide insight into the way patients’ neighborhood socioeconomic status (SES) and baseline allostatic load (AL) affect disease burden and outcomes.

SDOH 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.

“Probable explanations for the influence of SDOH in patients with MM rests on a complex interplay between resource availability (eg, 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 patients who have cancer patients, AL has been associated with increased mortality.

The current study focused on several end points 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, noncompletion 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 are indicative of greater neighborhood deprivation) and a median AL score of 2.

Overall, higher AL scores were associated with higher fatigue at baseline and with worse OS. A 1-unit increase in baseline AL produced greater odds 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 worse bother at baseline, with an OR of 4.49 compared with low SES. Middle nSES scores were associated with an OR of 4.22 compared with low SES. However, high fatigue or pain at baseline were not associated with SES levels.

Neither AL nor SES were associated with symptom burden at 5.5 months, noncompletion of therapy, or PFS. And although AL could potentially be predictive of OS and help tailor treatment to each patient, SES was not associated with OS in this study.

The study’s findings regarding the association of AL and OS in patients with MM are consistent with previous studies of AL in patients with other cancer types. However, knowledge gaps remain when it comes to exactly why AL is associated with worse outcomes in patients with cancer.

One study limitation was the limited availability of AL biomarkers in the overall clinical trial cohort, since AL was not an aim of the trial itself. Another limitation was the study population, because patients participating in clinical trials are often younger, wealthier, and have higher education milestones. With a wider population, the effects may be more significant.

More research is needed to confirm that AL is a potential prognostic biomarker for OS, but overall, the findings of this study add to prior work suggesting high baseline AL scores may affect outcomes across cancer types.

“The clinical meaningfulness of AL needs to be contextualized within a patient’s values and goals for treatment,” the authors wrote. “For example, a patient with a high AL may be interested in participating in psychosocial support services (eg, stress reduction) that would reduce their AL and increase their overall survival. Specifically, the 20% increase in the risk of death from any cause with every 1 unit increase in AL may be high enough threshold for them to consider AL risk-reducing strategies.”

Reference

Obeng-Gyasi S, Graham N, Kumar S, et al. Examining allostatic load, neighborhood socioeconomic status, symptom burden and mortality in multiple myeloma patients. Blood Cancer J. Published online April 1, 2022. doi:10.1038/s41408-022-00648-y