Multiple myeloma (MM) is a heterogeneous disease. Evaluation of prognostic factors and risk stratification at diagnosis is necessary to compare outcome. Attempts have been made to apply a comorbidity score in the clinical sitting, but a standardized general approach is still lacking.

We hypothesized that a comprehensive examination of every associated disease in a large cohort of patients could better highlight the prognostic impact of comorbidity in MM.

All consecutive patients diagnosed in our institution, from 1993 to 2013, with symptomatic MM according to IMWG criteria were included in our population-based MM registry. Patients with plasma cell leukemia or with palliative management were excluded. Clinical variables analyzed were: age, sex, Durie-Salmon, International Scoring System (ISS), percentage of plasma cell in bone marrow by morphology (PC), serum creatinine (Cr) and estimated glomerular filtration rate according with Modification of Diet in Renal Disease (eGFR-MDRD). The following comorbodities were analysed: hypertension (HTA), diabetes (DM), obesity (OB) (body mass index > 30 Kg/m2), hyperlipaemia (HL), prior malignancy (PM), hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), peptic ulcer (PU), thromboembolism (TE), renal transplant (RT), splenectomy (S), cutaneous disease (CD), amyloidosis (AM), heart disease (HD) (arrhythmia, congestive heart failure, coronary artery disease, other), lung disease (LD) (chronic obstructive pulmonary disease, asthma, other), liver disease (HE) (cirrhosis, non-alcoholic fatty liver disease, other), neurological disorder (ND), psychiatric disorder (PD) and rheumatologic disorder (RD). Kaplan-Meier method was used to estimate OS curves. Cox regression was used to determine the prognostic impact of each comorbidity in a univariate and multivariate model.

311 patients were eligible. Median age was 66 years (12-91), 148 men (47.6 %) and 163 women. Percentage of comorbidities was: HTA 45; OB 32.5; DM 20.4; HD 20.4; LD 15.2; PU 10; HL 9.7; ND 8; PM 7.8; PD 6.5; HBV 3.9; HE 3.9; TE 3.6; RD 3,5; AM 2.3; HCV 1.9; CD 1.6; S 1; RT 0.6; HIV 0.3. 63 patients (20.4 %) showed no comorbidities. Univariate analysis (table 1) demonstrated that AM (P=0.022), HCV (0.038), HIV (0.022), PD (0.015) and ND (0.05) were significantly associated with shorter OS. The variables associated with mortality in the multivariate analysis were age (p=0.002), ISS (III vs I: p=0.01), PC (p=0.05) and Cr (p=0.02). Results will be validated in another MM series and presented during the meeting.

ComorbidityDefinitionN (%)Median OSHR (95% CI)P-value
Hypertension -No
-Yes 		170
139 (45) 		31
34 		1,009
(0,764-1,332) 		0,951 
Diabetes -No
-Yes 		246
63 (20,4) 		32
42 		1,111
(0,794-1,554) 		0,540 
Obesity -No
-Yes 		164
79 (32,5) 		49
36 		1,226
(0,861-1,745) 		0,258 
Hyperlipaemia -No
-Yes 		279
30 (9,7) 		32
47 		0,723
(0,427-1,223) 		0,227 
Prior malignancy -No
-Yes 		285
24 (7,8) 		34
29 		1,172
(0,712-1,928) 		0,533 
HBV -No
-Yes 		297
12 (3,9) 		32
NR 		0,365
(0,117-1,142) 		0,083 
HCV -No
-Yes 		303
6 (1,9) 		33
7 		2,575
(1.053-6,294) 		0.038 
HIV -No
-Yes 		308
1 (0,3) 		33
1 		10,290
(1,402-75,542) 		0,022 
Peptic ulcer -No
-Yes 		278
31 (10) 		32
40 		0,971
(0,623-1,512) 		0,895 
Thromboembolism -No
-Yes 		298
11 (3,6) 		33
33 		1,777
(0,936-3,372) 		0,079 
Renal transplant -No
-Yes 		307
2 (0,6) 		33
5 		2,075
(0,288-14,934) 		0,468 
Splenectomy -No
-Yes 		306
3 (1) 		33
29 		1,559
0,386-6,302) 		0,533 
Cutaneous disease -No
-Yes 		304
5 (1,6) 		33
67 		0,598
(0,148-2,410) 		0,470 
Amyloidosis -No
-Yes 		303
7 (2,3) 		34
13 		2,428
(1,139-5,176) 		0,022 
Heart disease -No
-Yes
-Arrhythmia
-CHF
-CAD
-Other 		247
63 (20,4)
20
21
17
5 		33
32
32
42
29
25 		1,245
(0,898-1,727) 		0,189 
Lung disease -No
-Yes
-COPD
-Astma
-Other 		262
47 (15,2)
27

146 		32
33
31
52
33 		1,075
(0,740-1,562) 		0,702 
Liver disease -No
-Yes
-Cirrhosis
-NAFLD
-Other 		297
12 (3,9)
2
6
4 		33
10
1
8
16 		1,341
(0,709-2,536) 		0,367 
Neurological disorder -No
-Yes 		286
25 (8) 		34
24 		1,610
(0,989-2,621) 		0,056 
Psychiatric disorder -No
-Yes 		289
20 (6,5) 		33
15 		1,894
(1,130-3,176) 		0,015 
Rheumatologic disorder -No
-Yes 		300
11 (3,5) 		33
88 		0,702
(0,311-1,584) 		0,394 
ComorbidityDefinitionN (%)Median OSHR (95% CI)P-value
Hypertension -No
-Yes 		170
139 (45) 		31
34 		1,009
(0,764-1,332) 		0,951 
Diabetes -No
-Yes 		246
63 (20,4) 		32
42 		1,111
(0,794-1,554) 		0,540 
Obesity -No
-Yes 		164
79 (32,5) 		49
36 		1,226
(0,861-1,745) 		0,258 
Hyperlipaemia -No
-Yes 		279
30 (9,7) 		32
47 		0,723
(0,427-1,223) 		0,227 
Prior malignancy -No
-Yes 		285
24 (7,8) 		34
29 		1,172
(0,712-1,928) 		0,533 
HBV -No
-Yes 		297
12 (3,9) 		32
NR 		0,365
(0,117-1,142) 		0,083 
HCV -No
-Yes 		303
6 (1,9) 		33
7 		2,575
(1.053-6,294) 		0.038 
HIV -No
-Yes 		308
1 (0,3) 		33
1 		10,290
(1,402-75,542) 		0,022 
Peptic ulcer -No
-Yes 		278
31 (10) 		32
40 		0,971
(0,623-1,512) 		0,895 
Thromboembolism -No
-Yes 		298
11 (3,6) 		33
33 		1,777
(0,936-3,372) 		0,079 
Renal transplant -No
-Yes 		307
2 (0,6) 		33
5 		2,075
(0,288-14,934) 		0,468 
Splenectomy -No
-Yes 		306
3 (1) 		33
29 		1,559
0,386-6,302) 		0,533 
Cutaneous disease -No
-Yes 		304
5 (1,6) 		33
67 		0,598
(0,148-2,410) 		0,470 
Amyloidosis -No
-Yes 		303
7 (2,3) 		34
13 		2,428
(1,139-5,176) 		0,022 
Heart disease -No
-Yes
-Arrhythmia
-CHF
-CAD
-Other 		247
63 (20,4)
20
21
17
5 		33
32
32
42
29
25 		1,245
(0,898-1,727) 		0,189 
Lung disease -No
-Yes
-COPD
-Astma
-Other 		262
47 (15,2)
27

146 		32
33
31
52
33 		1,075
(0,740-1,562) 		0,702 
Liver disease -No
-Yes
-Cirrhosis
-NAFLD
-Other 		297
12 (3,9)
2
6
4 		33
10
1
8
16 		1,341
(0,709-2,536) 		0,367 
Neurological disorder -No
-Yes 		286
25 (8) 		34
24 		1,610
(0,989-2,621) 		0,056 
Psychiatric disorder -No
-Yes 		289
20 (6,5) 		33
15 		1,894
(1,130-3,176) 		0,015 
Rheumatologic disorder -No
-Yes 		300
11 (3,5) 		33
88 		0,702
(0,311-1,584) 		0,394 
View Large

The overall prognosis of MM depends on a variety of host and disease-related characteristics. We confirm age, ISS, PC and Cr as robust and independent prognostic factors. Adjusting for these factors, no isolated comorbidity reach statistical significance; however, comorbidity seems to have a role in MM prognosis. More studies are warranted to define the prognostic impact of comorbidities in MM.

Disclosures:

No relevant conflicts of interest to declare.

Topics:
comorbidity, multiple myeloma, obesity, amyloidosis, asthma, cancer, cardiac arrhythmia, chronic obstructive airway disease, congestive heart failure, diabetes mellitus

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2013 by The American Society of Hematology
2013
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