Graduate Institute of Medicine, China Medical University, Taichung, Taiwan.
PLoS One. 2013 Jul 2;8(7):e68041. doi: 10.1371/journal.pone.0068041. Print 2013.
Studies involving second malignancies in patients with multiple myeloma are limited for the Asian population. Using data from population-based insurance claims, we assessed the risk of developing secondary malignancies after multiple myeloma, in particular hematologic malignancies. A retrospective cohort study was conducted in 3970 patients with newly diagnosed multiple myeloma from the registry of catastrophic illnesses between 1997 and 2009. A total of 15880 subjects without multiple myeloma were randomly selected as comparisons from the insured population, frequency-matched based on gender, age, and the date of diagnosis. The incidence of secondary malignancies was ascertained through cross-referencing with the National Cancer Registry System. The Cox proportional hazards model was used for analyses. The incidence of multiple myeloma in the insured population increased annually. The overall incidence of secondary malignancy was lower in the multiple myeloma cohort than in the comparison cohort (93.6 vs. 104.5 per 10,000 person-years, IRR = 0.90, 95% CI = 0.78-1.04). The incidence of hematologic malignancies was 11-fold greater for multiple myeloma patients (47.2 vs. 4.09 per 10,000 person-years) with an adjusted HR of 13.0 (95% CI = 7.79-21.6) compared with the comparison cohort. The relative risk of secondary malignancy was also strong for myeloid leukemia (21.2 vs. 1.36 per 10,000 person-years). Gender- and age-specific analysis for secondary hematologic malignancies showed that males and patients with multiple myeloma <60 years of age had a higher risk of secondary malignancy than females and patients with multiple myeloma >60 years of age. In conclusion, patients with multiple myeloma, especially younger patients, are at a high risk of hematologic malignancies.
在亚洲人群中，涉及多发性骨髓瘤患者第二恶性肿瘤的研究是有限的。本研究使用基于人群的保险理赔数据，评估了多发性骨髓瘤后发生继发性恶性肿瘤的风险，特别是血液系统恶性肿瘤。在 1997 年至 2009 年期间，对登记在册的灾难性疾病患者中 3970 例新诊断为多发性骨髓瘤的患者进行了回顾性队列研究。从参保人群中随机选择了 15880 名无多发性骨髓瘤的个体作为对照，按照性别、年龄和诊断日期进行频率匹配。通过与国家癌症登记系统交叉核对来确定继发性恶性肿瘤的发生率。采用 Cox 比例风险模型进行分析。参保人群中多发性骨髓瘤的发病率逐年增加。多发性骨髓瘤组的继发性恶性肿瘤总发病率低于对照组（多发性骨髓瘤组为 93.6/10000 人年，对照组为 104.5/10000 人年，IRR=0.90，95%CI=0.78-1.04）。多发性骨髓瘤患者血液系统恶性肿瘤的发病率高 11 倍（多发性骨髓瘤组为 47.2/10000 人年，对照组为 4.09/10000 人年），调整后的 HR 为 13.0（95%CI=7.79-21.6）。与对照组相比，多发性骨髓瘤患者发生髓性白血病的相对风险也很高（21.2/10000 人年）。针对继发性血液系统恶性肿瘤的性别和年龄特异性分析表明，男性和<60 岁的多发性骨髓瘤患者比女性和>60 岁的多发性骨髓瘤患者发生继发性恶性肿瘤的风险更高。总之，多发性骨髓瘤患者，尤其是年轻患者，发生血液系统恶性肿瘤的风险较高。
