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Experiences from the Swedish Myeloma Registry
A
B
the study period. A total of 5.2% of reported MM patients did not receive any anti-myeloma treatment the first year after diagnosis and, notably, this involved 11% of patients over 80 years of age. Bisphosphonates were given in 79% of patients aged 65 years or under, and in 67% in patients over 65 years of age. There was an increase in the use of one or more of the novel drugs (thalidomide, lenalido- mide, and bortezomib) over the study period (Table 3).
Response
The proportion of patients achieving very good partial remission (VGPR) or better after first-line treatment increased from 36% in patients diagnosed in 2008 to 54% in 2014 (P<0.05). The increase was seen in all age groups, but was more pronounced in patients aged over 80 years, where the proportion of patients reaching VGPR or better rose from 14% to 33% (Table 4).
Survival in all myeloma patients
The 1-, 3-, and 5-year OS in all patients (SMM+MM) was 81%, 59%, 42%, and the corresponding RS was 84%, 65%, and 49%, respectively. Survival in 10-year cohorts in all myeloma patients is shown in Online Supplementary
Figure 3. Relative survival in active myeloma (MM) by treatment response in the Swedish Myeloma Registry in age cohorts: (A) under 65 years of age and (B) 66 years of age and over. CR: complete remission; VGPR: very good partial remission; PR: partial remission; n: number.
Table S1 and Figure S2. Early death (<1 year after diagnosis) was observed in 19% of patients. The 3-year RS was 62% (95%CI: 59.7-64.6) in women, and 67% (95%CI: 65.0- 69.3) in men. After age standardization, the 3-year RS in women was 67% (95%CI: 65.1-69.6) and 70% in men (95%CI: 67.8-71.8). Survival per SMM and MM diagnosis is shown in Online Supplementary Tables S2 and S3.
Survival in MM
In patients with MM and reported follow up (n=3558), the median OS varied considerably depending on age at diagnosis, ranging from 7.8 years in patients aged 60 years and under, to 1.5 years for patients aged 80-89 years (Online Supplementary Table S4). After a median follow up of 5.5 years, the median OS in the youngest cohort (<50 years) had not yet been reached (Figure 2). The median RS of patients aged 65 years or under was 7.7 years, and 3.4 years in those aged 66 years and over. The 5-year OS and RS in MM patients was 38.3% and 44.9%, respectively. The median RS according to ISS stage was 3.2 years and 5.6 years for stages III and II, and 8.2 years for stage I. Patients with no reported stage had a similar median RS as stage III patients of three years.
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