Page 146 - Haematologica3

Correspondence:
cecilie.blimark@vgregion.se
Received: August 4, 2017. Accepted: December 7, 2017. Pre-published: December 7, 2017.
doi:10.3324/haematol.2017.178103
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Plasma Cell Disorders
Outcome and survival of myeloma patients diagnosed 2008-2015. Real-world data on 4904 patients from the Swedish Myeloma Registry
Cecilie Hveding Blimark,1 Ingemar Turesson,2 Anna Genell,3 Lucia Ahlberg,4 Bo Björkstrand,5 Kristina Carlson,6 Karin Forsberg,7 Gunnar Juliusson,8
Olle Linder,9 Ulf-Henrik Mellqvist,1,10 Hareth Nahi11 and Sigurdur Y. Kristinsson12,13
1Department of Hematology, Sahlgrenska University Hospital and Institution of Internal Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden; 1Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund-Malmö, Sweden; 3Regional Cancer Center West, Western Sweden Health Care Region, Gothenburg, Sweden; 4Division of Hematology, Linkoping University Hospital, Linkoping, Sweden; 5Internal Medicine /Hematology, Karolinska Institutet, Stockholm, Sweden; 6Department of Hematology, Uppsala University Hospital, Sweden; 7Department of Hematology, Umeå University Hospital, Sweden; 8Hematology/Transplantation, Stem Cell Center, Lund University, Sweden; 9Department of Hematology, Örebro University Hospital, Sweden; 10Department of Hematology, Borås Hospital, Sweden; 11Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden; 12Department of Medicine and Division of Hematology, University of Iceland, Reykjavik, Iceland and 13Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden; for the Swedish Myeloma Registry
ABSTRACT
Epidemiology and outcome of myeloma are mainly reported from large university centers and collaborative groups, and do not repre- sent 'real-world' patients. The Swedish Myeloma Registry is a prospective population-based registry documenting characteristics, treat- ment and outcome in newly diagnosed myeloma, including asympto- matic and localized forms, with the purpose of improving disease man- agement and outcome. This report presents information on patients diag- nosed between 2008 and 2015, including data on first-line treatment in patients diagnosed up to 2014, with a follow up until December 2016. We present age-adjusted incidence, patients' characteristics at baseline, treat- ment, response, and survival. Baseline data were available with a 97% coverage in 4904 patients (median age 71 years, males 70 years, females 73 years; 72% were 65 years or older), and at 1-year follow up in 3558 patients with symptomatic disease (92% of patients initially reported). The age-adjusted incidence was 6.8 myeloma cases per 100,000 inhabi- tants per year. Among initially symptomatic patients (n=3988), 77% had osteolytic lesions or compression fractures, 49% had anemia, 18% impaired kidney function, and 13% hypercalcemia. High-dose therapy with autologous stem cell transplantation was given to 77% of patients aged up to 66 years, and to 22% of patients aged 66-70 years. In the study period, 68% received bortezomib, thalidomide, and/or lenalidomide as part of the first-line treatment, rising from 31% in 2008 to 81% in 2014. In active myeloma, the median relative survival of patients aged 65 years or under was 7.7 years, and 3.4 years in patients aged 66 years and over. Patients diagnosed with myeloma in more recent years were associated with significantly higher rates of complete or very good partial remission (P<0.05), and with a significantly higher survival, with a Hazard Ratio (HR) of 0.84 (95%CI: 0.77-0.92; P<0.05). There was a small, but significant survival benefit in patients treated at university hospitals (HR 0.93; 95%CI: 0.87-0.99; P<0.05). We report here on a near complete 'real-world' population of myeloma patients during an 8-year period; a period in which newer drugs were implemented into standard practice. The overall incidence and median age were both higher than in most previous studies, indicating a more complete coverage of older patients. Myeloma survival in Sweden is comparable to other large registry studies, and responses and survival improved during the study period.
Haematologica 2018 Volume 103(3):506-513
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haematologica | 2018; 103(3)
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