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C.H. Blimark et al. A
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treatment program for multiple myeloma (2005),17 and the Swedish 2010 National Guidelines (up-dated in 2013). Briefly, high-dose melphalan and autologous transplantation (HDM- ASCT) was recommended as up-front treatment for all MM patients aged 65 years or under, and in patients aged 66-70 years if they had good performance status. In 2005, vincristine, adri- amycin, and dexamethasone (VAD) or similar combinations were recommended as induction treatment before HDM-ASCT, and later, in the 2010 guidelines, bortezomib and thalidomide became part of standard induction, following an introduction period sub- sequent to approval in 2004. Patients at smaller hospitals are, as a rule, only referred to university hospitals for the ASCT procedure and afterwards return to their hospital of origin. For patients aged 66 years and older, melphalan and prednisone (MP) or cyclophos- phamide and dexamethasone (CyDex) was standard up-front treatment until 2004 when melphalan, prednisone and thalido- mide (MPT) was incorporated as a treatment option. In 2010, MPT was the standard for patients not eligible for ASCT, and MP and bortezomib (MPV) were treatment options. In the 2013 ver- sion, both MPT and MPV were standard up-front treatments in those patients not eligible for ASCT.
Statistical analysis
Incidence was extracted from the Swedish National Board of Health statistical database on cancer 1970-2015, which includes all patients with the diagnosis ICD 203*.18 All other analyses were performed on patients reported to the Myeloma Registry with a 97% coverage compared to the Swedish Cancer Registry.19 For diagnoses of MM and SMM, we summarized descriptive statistics
Figure 1. Age distribution in the Swedish Myeloma Registry in men and women in (A) active myeloma (MM) and (B) smoldering myelo- ma (SMM). n: number.
Table 2. Prevalence of myeloma-related organ and tissue impairment (ROTI) and International Staging System (ISS) stage at diagnosis in patients with active myeloma at diagnosis in the Swedish Myeloma Registry.
Patients n=3988
ROTI (%)
Anemia* 49% Renal impairment** 18% Hypercalcemia*** 13% Skeletal disease 77%
ISS stage (%)
Stage I 23 Stage II 44 Stage III 33
n: number; in patients with report on: *anemia defined as hemoglobin < 10g/dL and reduction of 2g/dL from the normal value; **renal failure defined as creatinine >173 mol/L; ***hypercalcemia defined as s-calcium (uncorrected) > 2.75 mmol/L or ion-
ized calcium>1.45 mmol/L.
at diagnosis. We tabulated categorical variables such as sex, Ig-
class and use of new drugs. Summary statistics, for example,
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median and range, were calculated for continuous variables such
as age and β M. The χ2 test was used as significance test of differ- 2
ence in proportions. Statistical analysis of treatment was only car- ried out on MM patients with a reported 1-year follow up, includ- ing patients who had developed symptomatic disease after SMM
haematologica | 2018; 103(3)