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THE IMPACT OF THE TYPE OF MYELOMA-DEFINING EVENT ON EARLY MORTALITY AND SURVIVAL
Author(s): ,
Rafael Ríos-Tamayo
Affiliations:
Hematology,University Hospital Virgen de las Nieves,Granada,Spain
,
Juan Sáinz
Affiliations:
Hematology,University Hospital Virgen de las Nieves,Granada,Spain
,
Álvaro Miguel Alba
Affiliations:
Hematology,University Hospital Virgen de las Nieves,Granada,Spain
,
Antonio Jesús Cruz
Affiliations:
Hematology,University Hospital Virgen de las Nieves,Granada,Spain
,
José Andrés Pérez
Affiliations:
Hematology,University Hospital Virgen de las Nieves,Granada,Spain
,
Estefanía Morente
Affiliations:
Hematology,University Hospital Virgen de las Nieves,Granada,Spain
,
Elena Cornejo
Affiliations:
Hematology,University Hospital Virgen de las Nieves,Granada,Spain
,
José Luís García de Veas
Affiliations:
Immunology,University Hospital Virgen de las Nieves,Granada,Spain
,
Teresa Rodríguez
Affiliations:
Immunology,University Hospital Virgen de las Nieves,Granada,Spain
,
Manuel Jurado
Affiliations:
Hematology,University Hospital Virgen de las Nieves,Granada,Spain
,
Joaquín Martínez-López
Affiliations:
Hematology,University Hospital12 de Octubre,Madrid,Spain
Juan José Lahuerta
Affiliations:
Hematology,University Hospital12 de Octubre,Madrid,Spain
(Abstract release date: 05/19/16) EHA Library. Rios-Tamayo R. 06/09/16; 132864; E1315
Dr. Rafael Rios-Tamayo
Dr. Rafael Rios-Tamayo
Contributions
Abstract
Abstract: E1315

Type: Eposter Presentation

Background
Multiple myeloma (MM) is a complex disease with several levels of heterogeneity. The impact of the clinical presentation of MM is probably underestimated in daily clinical practice. The relationship between the initial clinical presentation in MM and the outcome in terms of overall survival (OS) has been recently highlighted (Greenberg et al, 2014). In this study, patients were divided into four groups: renal failure, anemia, lytic bone disease and a mixed group. They showed that patients with isolated RF as myeloma-defining event (MDE) had the worst OS, whereas patients with bone disease had the best outcome. However, there are many other well-established MDE that can be further analyzed in this regard. On the other hand, little is known about the impact of MDE on early mortality.

Aims
The aim of this study is to assess the impact of the key MDE on the outcome of MM patients, in terms of early mortality and OS.

Methods
All newly diagnosed MM patients recorded in our population-based registry for which the MDE is known were analyzed. Patients were divided into nine groups according with the key MDE: bone pain, pathological fracture, anemia, constitutional syndrome (weight loss, decreased appetite, malaise), infection, other, tumor, renal failure and mixed group (a combination of pain, renal failure, anemia and other). Median OS was estimated in months by the Kaplan-Meier method. Log-rank test was used to compare OS curves. Early mortality was analyzed at two, six, and twelve months. 

Results
The MDE was available in 398 patients. Bone disease is the most frequent MDE (49% isolated bone pain, 8% pathological fracture), followed by anemia (9.5%). A constitutional syndrome was present in 7.5%, the same percentage as the mixed group. Isolated renal failure was detected in 6.3%, infection in 5.3%, other in 4.5% and a tumor in 2.3%.Median OS for the whole cohort was 32.7 months (IC 95%, 25-40.4). There were statistically significant differences in OS between subgroups (p=0.004). The subgroup with the best OS was anemia (77.6 months) and the worst was constitutional syndrome (8.9 months). The mixed group and the renal failure group had 20.4 and 21.8 months, respectively. In patients with bone disease, OS of those with isolated bone pain reach 40.4, but falls to 18 months for those with pathological fracture.Early mortality at two months was observed in 53 patients (13.5%), whereas 87 patients (22.7%), and 116 (31.9%) had mortality at six and twelve months, respectively. In relation to the group constitutional syndrome, 24.1, 40.7, and 60% died at 2, 6, and 12 months. For those with pathological fracture, the percentages were 12.9, 25.8 and 45.2%, respectively. The mixed group had 13.3, 28.6 and 44.4%. Patients with renal failure had 21.7, 34.8 and 36.4% mortality, respectively.

Conclusion
The importance of clinical evaluation at diagnosis in MM should be emphasized. Patients presenting with isolated anemia as the MDE have the best survival, whereas those with constitutional syndrome have the worst prognosis. Patients having constitutional syndrome, pathological fracture, renal failure or those in the mixed group as the key MDE have a poor outcome in terms of early mortality and OS. The potential association between the MDE and other prognostic factors should be analyzed in depth.

Session topic: E-poster

Keyword(s): Mortality, Multiple myeloma, Survival
Abstract: E1315

Type: Eposter Presentation

Background
Multiple myeloma (MM) is a complex disease with several levels of heterogeneity. The impact of the clinical presentation of MM is probably underestimated in daily clinical practice. The relationship between the initial clinical presentation in MM and the outcome in terms of overall survival (OS) has been recently highlighted (Greenberg et al, 2014). In this study, patients were divided into four groups: renal failure, anemia, lytic bone disease and a mixed group. They showed that patients with isolated RF as myeloma-defining event (MDE) had the worst OS, whereas patients with bone disease had the best outcome. However, there are many other well-established MDE that can be further analyzed in this regard. On the other hand, little is known about the impact of MDE on early mortality.

Aims
The aim of this study is to assess the impact of the key MDE on the outcome of MM patients, in terms of early mortality and OS.

Methods
All newly diagnosed MM patients recorded in our population-based registry for which the MDE is known were analyzed. Patients were divided into nine groups according with the key MDE: bone pain, pathological fracture, anemia, constitutional syndrome (weight loss, decreased appetite, malaise), infection, other, tumor, renal failure and mixed group (a combination of pain, renal failure, anemia and other). Median OS was estimated in months by the Kaplan-Meier method. Log-rank test was used to compare OS curves. Early mortality was analyzed at two, six, and twelve months. 

Results
The MDE was available in 398 patients. Bone disease is the most frequent MDE (49% isolated bone pain, 8% pathological fracture), followed by anemia (9.5%). A constitutional syndrome was present in 7.5%, the same percentage as the mixed group. Isolated renal failure was detected in 6.3%, infection in 5.3%, other in 4.5% and a tumor in 2.3%.Median OS for the whole cohort was 32.7 months (IC 95%, 25-40.4). There were statistically significant differences in OS between subgroups (p=0.004). The subgroup with the best OS was anemia (77.6 months) and the worst was constitutional syndrome (8.9 months). The mixed group and the renal failure group had 20.4 and 21.8 months, respectively. In patients with bone disease, OS of those with isolated bone pain reach 40.4, but falls to 18 months for those with pathological fracture.Early mortality at two months was observed in 53 patients (13.5%), whereas 87 patients (22.7%), and 116 (31.9%) had mortality at six and twelve months, respectively. In relation to the group constitutional syndrome, 24.1, 40.7, and 60% died at 2, 6, and 12 months. For those with pathological fracture, the percentages were 12.9, 25.8 and 45.2%, respectively. The mixed group had 13.3, 28.6 and 44.4%. Patients with renal failure had 21.7, 34.8 and 36.4% mortality, respectively.

Conclusion
The importance of clinical evaluation at diagnosis in MM should be emphasized. Patients presenting with isolated anemia as the MDE have the best survival, whereas those with constitutional syndrome have the worst prognosis. Patients having constitutional syndrome, pathological fracture, renal failure or those in the mixed group as the key MDE have a poor outcome in terms of early mortality and OS. The potential association between the MDE and other prognostic factors should be analyzed in depth.

Session topic: E-poster

Keyword(s): Mortality, Multiple myeloma, Survival

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