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C.H. Blimark et al.
Table 3. Proportion of patients who received novel drugs (thalidomide, bortezomib or lenalidomide) as first-line line treatment among active myeloma patients with reported follow up, by year of diagnosis and by age group (-65, 66–80, >80) years in the Swedish Myeloma Registry.
Patients
with novel drugs first line
2008-2014
2008
2009
2010
2011
2012
2013
2014*
*2014 has less follow up on patients reported (at data cut off 78.7% of initially reported).
All ages n=2400 (%)
66-80 years n=1212 (%)
72.6 42.0 55.7 74.1 76.0 83.3 88.1 86.2
>80 years n=275 (%)
35.6 17.7 24.8 32.6 34.5 37.3 49.2 54.3
≤65 years n=913 (%)
67.5 31.1 56.1 69.1 75.2 77.0 81.0 81.1
81.3 24.4 76.8 91.6 93.8 98.1 95.6 92.2
Table 4. Proportion with very good partial remission (VGPR) or better among active myeloma patients with reported follow up after first-line treat- ment in patients diagnosed 2008-2014 in the Swedish Myeloma Registry, by year of diagnosis and by age group (-65, 66-80, >80 years).
Patients All ages ≤65 years 66-80 years >80 years VGPRorbetter n(%) n(%) n(%) n(%)
2008-2014 1415 (45.8)
2008 152 (36.1)
2009 173 (40.3)
2010 209 (47.5)
2011 223 (45.4)
2012 223 (46.4)
2013 230 (51.6)
2014* 205 (53.5)
*2014 has less follow up on patients reported (at data cut off 78.7% of initially reported).
(Table 1), and at 1-year follow up for 3558 of all MM cases diagnosed 2008-2014, being 92% of all MM initially reported 2008-2014. Data were reported from 74 different centers in Sweden, approximately 40% from university hospitals, and 60% from regional and smaller hospitals, all public care institutions. The median time of follow up of all SMM and MM patients was 4.9 years.
The total crude and age-adjusted (to the population in Sweden in the year 2000) incidence was 7.0 and 6.8 cases per 100,000 inhabitants, respectively (8.0 and 8.2 for men, and 6.0 and 5.3 for women per 100,000 inhabitants, respectively). The corresponding incidences for European and World standard populations are 4.8 and 3.2, respec- tively. Due to the difference in age distribution in the pop- ulation, the total number of women was higher in the cohort aged over 85 years (Figure 1). However, the age- specific incidence was higher amongst men in all ages, and the difference increased with advancing age (Online Supplementary Figure S1). The median age of patients reported to the registry with a diagnosis of MM or SMM was 71 years (70 years for men and 73 years for women; 71 years for all MM and 72 years for all SMM). Twenty- four percent of patients were 80 years or older at the time of diagnosis. Notably, the percentage of patients aged under 65 years was 28.3%; 61.4% of these were men and 38.6 women.
575 (38.9) 56 (28.0) 58 (23.4) 86 (43.9) 91 (35.1) 91 (39.6) 94 (46.8) 99 (50.5)
Baseline characteristics
115 (20.8) 9 (14.3) 18 (23.4) 19 (21.1) 9 (14.5) 18 (18.8) 19 (20.0) 23 (33.3)
725 (68.3) 87 (55.1) 97 (62.2)
104 (67.5) 123 (72.4) 114 (73.5) 117 (78.0) 83 (70.3)
510
Serum protein electrophoresis was performed in 99.5% of all patients and a skeletal survey was performed in 97%. A bone marrow sample was taken in 97% of patients at diagnosis, with a median of 27% plasma cells in MM patients and 15% in SMM. Among patients with MM at diagnosis (n=3988), 77% had reported osteolytic lesions and/or compression fractures at diagnosis, and this did not increase over the study period. Anemia was seen in 49%, renal insufficiency (s-creatinine >173 μmol/L) in 18%, and creatinine levels more than 110 μmol/L were reported in 33% of MM patients. Hypercalcemia was reported in 13% of MM patients at the time of diagnosis (Table 2). The number of patients aged 80 years and under who had FISH performed at diagnosis increased over the study period, from 30% in the period 2008-2010, to 43% in 2011-2015. Staging according to the ISS was reported in 71% of patients with MM in the study period. In MM patients with reported ISS-stage, 23% were ISS stage I, 44% stage II, and 33% stage III (Table 2).
Treatment
Of all patients with reported follow up, 77% of patients aged 65 years or under at diagnosis and 5% of patients aged over 66 years received HDM-ASCT as first-line treat- ment. In patients aged 66-70 years, HDM/ASCT was per- formed in 22%. Allogeneic transplantation as part of first- line treatment was performed in only 1% of patients in
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