Incidence and treatment of multiple myeloma at the Department of Hematology of the University Medical Centre Ljubljana in the period 2008-2011

Abstract

Backgrounds: Multiple myeloma (MM) among the most frequent lymphoproliferative disorders in the developed world. As to Slovenia, we have no available data regarding patients who are diseased and are receiving treatment. Methods: Data were collected with PC Windows Excel and the survival analysed with SPSS 16.0. Data were collected for the period from 1 January 2008 to 31 December 2011. Patients' age, sex, their distribution among regions in Slovenia, MM subtype and cytogenetic abnormalities were collected. Patients were categorised according to the prognostic ISS international scoring system (score 1, 2 or 3); we colllected the type and therapeutic response to MM induction treatment and subsequent autologous or allogenic HSCT if performed. Results: During the four-year period we treated 350 patients with MM, 188 males (53.7 %) and 162 females (46.3 %); 171/350 (49 %) patients were younger than 70 years (mean age 59 years) and 179/350 patients (51 %) older than 70 years (mean age 79.5 years); 191/350 (54.6 %) were from Ljubljana region. MM incidenca for Ljubljana is 7.5 patients/year/100,000 inhabitants. In 56.9 % the main subtype was IgG, followed by Bence Jones subtype in 21.2 % and by IgA subtype in 18.9 % . ISS scoring system was evaluable in only 134/350 patients (38.2 %). 9.4 % patients were in group 1, 11.4 % in group 2 and 17.4 % in most unfavourable group 3. In 232/350 patients (66.3 %) the result of FISH (»flourescent in situ hibridisaton«) cytogenetics were performed and further evaluated in 213/232 patients. 60/213 (28.2 %) patients had no FISH detected abnormalities. In others, most frequent were del(13), amp(15q), amp(1q), del(17p), t(4;14), del (6q), ... (47.9 %, 44.7 %, 33.3 %, 10.4 %, 9.4 %, 9.1 %). In most patients chromosomal rearrangements were complex and not isolated ones. Among the latter, the most frequent was del(13) in 61/213 patients (28.6 %). 209/350 (59.7 %) patients received a combination of bortezomib and dexamethasone (VD) as first induction treatment, followed by VAD scheme (vincristine, adriamycin, dexamethasone) in 17.1 % and TD (thalidomide dexamethasone), AP (melphalan, methylprednisolone) and VMP (bortezomib, melphalan, methylprednisolone) in 6.3 %, 5.4 % and 4.6 %. With all treatment regimens we achieved a complete remission (CR) of MM in 7.4 % of patients, very good partial response (VGPR) in 16.3 % of patients, partial response (PR) in 42.3 %, but in 18.6 % of patients MM parameters remained stable (SD) or even progressed in 7.1 % of patients (PD). After the induction treatment, 125/350 patients (35.7 %) proceeded to treatment with autologous HSCT and 1/350 (0.3 %) with allogeneic HSCT. 126/350 (36 %) patients relapsed after induction, HSCTtreated patients included. In the context of reinduction treatment, most frequently VD, followed by RD (lenalidomide, dexamethasone), AP and TD were used. 27/350 patients (7.7 %) were at that point treated with tandem autologous HSCT and 6/350 (1.7 %) with allogeneic HSCT. 104/350 patiens died. Average survival for the whole group was 31.6 months and median survival 46.1 months. Survival is statistically longer (p < 0.0001) in patients who had ISS score 1, achived CR or VGPR after induction and were treated with autologous HSCT. Conclusions: The incidence of MM and treatment-related results of MM in Slovenia are expected and comparable with similar data from Western countries. It is important to note that most important contributors are the availability of newer drugs (bortezomib, lenalidomide, thalidomide) in Slovenia and treatment with autologous HSCT.