THE ROLE OF COMORBIDITY ON EARLY MORTALITY IN MULTIPLE MYELOMA. A SINGLE INSTITUTION POPULATION-BASED STUDY EMPHASIZING THE NEED FOR STANDARDIZATION
(Abstract release date: 05/19/16)
EHA Library. Rios-Tamayo R. 06/09/16; 134859; PB1959
Dr. Rafael Rios-Tamayo
Contributions
Contributions
Abstract
Abstract: PB1959
Type: Publication Only
Background
Multiple myeloma (MM) is a very heterogeneous and complex disease with variable survival. The variability in the outcome cannot be fully explained by the current systems of stratification. Early mortality (EM) remains a serious obstacle to further improve the recent trend towards increased survival demonstrated in recent years (Ríos-Tamayo et al, 2015). However, the definition of EM is not standardized, precluding a proper comparison between studies. Furthermore, no study has systematically focused on the impact of comorbidity on EM in MM to date
Aims
The aim of this study is to assess the impact comorbidity on the outcome of MM patients, in terms of EM, in a large cohort of real-life patients. On the other hand, all relevant studies on this topic to date have been critically analyzed.
Methods
All newly diagnosed symptomatic MM patients recorded in our population-based registry from January 1985 to December 2015 were analyzed. The study was divided into six periods of five years. Twenty baseline comorbidities were studied, along with common prognostic factors. EM was measured at three key cutoff points: two (EM2), six (EM6) and twelve (EM12) months. Univariate and multivariate binary logistic regression models were used to test independent variables as risk factors for EM.
Results
Six hundred and thirty-one MM patients were recruited in our MM clinical registry during the period of study. A complete assessment of comorbidity was available in 426 patients (68.6%) at the moment of diagnosis. Excluding patients not fit for MM-directed therapy, the percentage for EM2, EM6 and EM 12 was 10.6%, 20% and 28.6%, respectively. For the whole cohort, only age and serum creatinine were independent risk factors for EM in all the cutoff points analyzed. The presence of respiratory disease and light chain MM (borderline) were associated with EM2, whereas the ISS III and liver disease were predictors for EM6, and finally, the lactate dehydrogenase level, the hepatitis virus C infection and the presence of respiratory disease were significantly associated to EM12.Table I highlights recent studies on this topic. The differences in the type of study as well as in the cutoff point used preclude appropriate comparisons.
Conclusion
The role of comorbidities in EM of MM patients remains to be determined. However, our study confirms the crucial role of renal failure and provides some evidence about the time-dependent impact of specific comorbidities in detailed cutoff points for EM. We suggest that all three cutoff points should be analyzed in the future, in order to allow comparisons between studies.
Session topic: E-poster
Keyword(s): Comorbidities, Mortality, Multiple myeloma
Type: Publication Only
Background
Multiple myeloma (MM) is a very heterogeneous and complex disease with variable survival. The variability in the outcome cannot be fully explained by the current systems of stratification. Early mortality (EM) remains a serious obstacle to further improve the recent trend towards increased survival demonstrated in recent years (Ríos-Tamayo et al, 2015). However, the definition of EM is not standardized, precluding a proper comparison between studies. Furthermore, no study has systematically focused on the impact of comorbidity on EM in MM to date
Aims
The aim of this study is to assess the impact comorbidity on the outcome of MM patients, in terms of EM, in a large cohort of real-life patients. On the other hand, all relevant studies on this topic to date have been critically analyzed.
Methods
All newly diagnosed symptomatic MM patients recorded in our population-based registry from January 1985 to December 2015 were analyzed. The study was divided into six periods of five years. Twenty baseline comorbidities were studied, along with common prognostic factors. EM was measured at three key cutoff points: two (EM2), six (EM6) and twelve (EM12) months. Univariate and multivariate binary logistic regression models were used to test independent variables as risk factors for EM.
Results
Six hundred and thirty-one MM patients were recruited in our MM clinical registry during the period of study. A complete assessment of comorbidity was available in 426 patients (68.6%) at the moment of diagnosis. Excluding patients not fit for MM-directed therapy, the percentage for EM2, EM6 and EM 12 was 10.6%, 20% and 28.6%, respectively. For the whole cohort, only age and serum creatinine were independent risk factors for EM in all the cutoff points analyzed. The presence of respiratory disease and light chain MM (borderline) were associated with EM2, whereas the ISS III and liver disease were predictors for EM6, and finally, the lactate dehydrogenase level, the hepatitis virus C infection and the presence of respiratory disease were significantly associated to EM12.Table I highlights recent studies on this topic. The differences in the type of study as well as in the cutoff point used preclude appropriate comparisons.
| TABLE I. Results of recent studies on NDMM early mortality | |||||||
| Authors (references) | Type of study | Study period | Year of publication | N.of patients | EM2 | EM 6 | EM12 |
| Augustson et al | Multicenter (UK) | 1980-2002 | 2005 | 3107 | 10 | - | - |
| Kastritis et al (abstract) | Single institution | 1994-2012 | 2013 | 509 | 6 | 13 | 18 |
| Terebelo et al (abstract) | Multicenter (USA) | 2009-2013 | 2013 | 1494 | - | 7 | - |
| Kumar et al. | Single institution | 2001-2010 | 2014 | 1038 | - | - | 13 |
| Dimopoulos et al | Multicenter (Greece) | 1990-2011 | 2014 | 1773 | 12/7/3a | - | - |
| Holmström et al | Multicenter (Denmark) | 2005-2012 | 2015 | 1497 | - | 22 | - |
| O’Donnell et al (abstract) | Single institution | 2005-2015 | 2015 | 836 | - | - | 32b |
| Hsu et al | Single institution | 2002-2015 | 2015 | 451 | 12.6 | - | - |
| Chen et al | Single institution | 2007-2013 | 2016 | 122 | - | 22.95 | - |
| Ríos-Tamayo et al | Single institution(population-based) | 1985-2015 | - | 621 | 10.6 | 20 | 28.6 |
| Abbreviations: NDMM= Newly diagnosed multiple myeloma, EM2=Early Mortality at two months, EM6=Early Mortality at six months, EM12=Early Mortality at twelve months, a % EM according to estimated glomerular filtration rate (<30, 30-59 or >30 ml/min), b % EM within 24 months. | |||||||
Conclusion
The role of comorbidities in EM of MM patients remains to be determined. However, our study confirms the crucial role of renal failure and provides some evidence about the time-dependent impact of specific comorbidities in detailed cutoff points for EM. We suggest that all three cutoff points should be analyzed in the future, in order to allow comparisons between studies.
Session topic: E-poster
Keyword(s): Comorbidities, Mortality, Multiple myeloma
Abstract: PB1959
Type: Publication Only
Background
Multiple myeloma (MM) is a very heterogeneous and complex disease with variable survival. The variability in the outcome cannot be fully explained by the current systems of stratification. Early mortality (EM) remains a serious obstacle to further improve the recent trend towards increased survival demonstrated in recent years (Ríos-Tamayo et al, 2015). However, the definition of EM is not standardized, precluding a proper comparison between studies. Furthermore, no study has systematically focused on the impact of comorbidity on EM in MM to date
Aims
The aim of this study is to assess the impact comorbidity on the outcome of MM patients, in terms of EM, in a large cohort of real-life patients. On the other hand, all relevant studies on this topic to date have been critically analyzed.
Methods
All newly diagnosed symptomatic MM patients recorded in our population-based registry from January 1985 to December 2015 were analyzed. The study was divided into six periods of five years. Twenty baseline comorbidities were studied, along with common prognostic factors. EM was measured at three key cutoff points: two (EM2), six (EM6) and twelve (EM12) months. Univariate and multivariate binary logistic regression models were used to test independent variables as risk factors for EM.
Results
Six hundred and thirty-one MM patients were recruited in our MM clinical registry during the period of study. A complete assessment of comorbidity was available in 426 patients (68.6%) at the moment of diagnosis. Excluding patients not fit for MM-directed therapy, the percentage for EM2, EM6 and EM 12 was 10.6%, 20% and 28.6%, respectively. For the whole cohort, only age and serum creatinine were independent risk factors for EM in all the cutoff points analyzed. The presence of respiratory disease and light chain MM (borderline) were associated with EM2, whereas the ISS III and liver disease were predictors for EM6, and finally, the lactate dehydrogenase level, the hepatitis virus C infection and the presence of respiratory disease were significantly associated to EM12.Table I highlights recent studies on this topic. The differences in the type of study as well as in the cutoff point used preclude appropriate comparisons.
Conclusion
The role of comorbidities in EM of MM patients remains to be determined. However, our study confirms the crucial role of renal failure and provides some evidence about the time-dependent impact of specific comorbidities in detailed cutoff points for EM. We suggest that all three cutoff points should be analyzed in the future, in order to allow comparisons between studies.
Session topic: E-poster
Keyword(s): Comorbidities, Mortality, Multiple myeloma
Type: Publication Only
Background
Multiple myeloma (MM) is a very heterogeneous and complex disease with variable survival. The variability in the outcome cannot be fully explained by the current systems of stratification. Early mortality (EM) remains a serious obstacle to further improve the recent trend towards increased survival demonstrated in recent years (Ríos-Tamayo et al, 2015). However, the definition of EM is not standardized, precluding a proper comparison between studies. Furthermore, no study has systematically focused on the impact of comorbidity on EM in MM to date
Aims
The aim of this study is to assess the impact comorbidity on the outcome of MM patients, in terms of EM, in a large cohort of real-life patients. On the other hand, all relevant studies on this topic to date have been critically analyzed.
Methods
All newly diagnosed symptomatic MM patients recorded in our population-based registry from January 1985 to December 2015 were analyzed. The study was divided into six periods of five years. Twenty baseline comorbidities were studied, along with common prognostic factors. EM was measured at three key cutoff points: two (EM2), six (EM6) and twelve (EM12) months. Univariate and multivariate binary logistic regression models were used to test independent variables as risk factors for EM.
Results
Six hundred and thirty-one MM patients were recruited in our MM clinical registry during the period of study. A complete assessment of comorbidity was available in 426 patients (68.6%) at the moment of diagnosis. Excluding patients not fit for MM-directed therapy, the percentage for EM2, EM6 and EM 12 was 10.6%, 20% and 28.6%, respectively. For the whole cohort, only age and serum creatinine were independent risk factors for EM in all the cutoff points analyzed. The presence of respiratory disease and light chain MM (borderline) were associated with EM2, whereas the ISS III and liver disease were predictors for EM6, and finally, the lactate dehydrogenase level, the hepatitis virus C infection and the presence of respiratory disease were significantly associated to EM12.Table I highlights recent studies on this topic. The differences in the type of study as well as in the cutoff point used preclude appropriate comparisons.
| TABLE I. Results of recent studies on NDMM early mortality | |||||||
| Authors (references) | Type of study | Study period | Year of publication | N.of patients | EM2 | EM 6 | EM12 |
| Augustson et al | Multicenter (UK) | 1980-2002 | 2005 | 3107 | 10 | - | - |
| Kastritis et al (abstract) | Single institution | 1994-2012 | 2013 | 509 | 6 | 13 | 18 |
| Terebelo et al (abstract) | Multicenter (USA) | 2009-2013 | 2013 | 1494 | - | 7 | - |
| Kumar et al. | Single institution | 2001-2010 | 2014 | 1038 | - | - | 13 |
| Dimopoulos et al | Multicenter (Greece) | 1990-2011 | 2014 | 1773 | 12/7/3a | - | - |
| Holmström et al | Multicenter (Denmark) | 2005-2012 | 2015 | 1497 | - | 22 | - |
| O’Donnell et al (abstract) | Single institution | 2005-2015 | 2015 | 836 | - | - | 32b |
| Hsu et al | Single institution | 2002-2015 | 2015 | 451 | 12.6 | - | - |
| Chen et al | Single institution | 2007-2013 | 2016 | 122 | - | 22.95 | - |
| Ríos-Tamayo et al | Single institution(population-based) | 1985-2015 | - | 621 | 10.6 | 20 | 28.6 |
| Abbreviations: NDMM= Newly diagnosed multiple myeloma, EM2=Early Mortality at two months, EM6=Early Mortality at six months, EM12=Early Mortality at twelve months, a % EM according to estimated glomerular filtration rate (<30, 30-59 or >30 ml/min), b % EM within 24 months. | |||||||
Conclusion
The role of comorbidities in EM of MM patients remains to be determined. However, our study confirms the crucial role of renal failure and provides some evidence about the time-dependent impact of specific comorbidities in detailed cutoff points for EM. We suggest that all three cutoff points should be analyzed in the future, in order to allow comparisons between studies.
Session topic: E-poster
Keyword(s): Comorbidities, Mortality, Multiple myeloma
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