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Early mortality in multiple myeloma
Leukemia (2015) 29, 16161618; doi:10.1038/leu.2015.33
The life expectancy of patients diagnosed with multiple myeloma (MM) in the US has improved substantially over the last two decades, a phenomenon affecting predominantly, but not exclusively, younger patients.1 This improvement in survival has been attributed to the broader use of autologous hematopoietic progenitor cell transplantation (AHPCT)2 and increasing availability of novel drugs both in the newly diagnosed and relapsed setting,1 as well as improved supportive care. The impact of these interventions in early mortality (EM, henceforth dened as death in the rst year after the diagnosis) is less well known.
A recent single-center report has indicated improvement in EM over the last decade in a large-volume, tertiary MM center.3 At the population level, the frequency of EM and the magnitude of its reduction over time are not well described.
We extracted data from the National Cancer Institute Surveillance Epidemiology and End Result Registry (SEER-13 covering 13.4% of the US population) to study EM in MM (including primary plasma cell leukemia, ICD-O-3 9732/3, and 9733/3) diagnosed during 19932010. Minimum 1-year follow up was available to the end of 2011. For each case, we extracted age, sex, SEER registry of origin, year of diagnosis, ICD-O-3 code, median household income in the county of residence, percentage of adult individuals with at least a bachelor's degree (a surrogate for education), duration of follow-up and vital status. Cases were grouped in main race-ethnicity categories: American Indian and Alaska Native (AIAN), Asian and Pacic Islanders (API), Hispanics (irrespective of race), non-Hispanic blacks (NHB) and non-Hispanic whites (NHW). We divided the patient population into two groups for the purpose of analysis: o65 years and 65 years. For the different demographic categories we described both absolute EM and relative
EM, the latter being 1 (actual survival)/(expected survival). Absolute and relative survival rates were estimated using the survival function of SEER*Stat8.1.5 and used population survival data from the 2000 US population.
There were 30 324 cases included in the analysis, 11 439 diagnosed at age o65 and 18 885 at age 65. Absolute EM for patients with newly diagnosed MM was 28.6% (26.1% relative EM).
Among younger patients, absolute and relative EM were 17.6% and 16.9%, whereas...