Medaffcon Oy, Espoo, Finland.
Takeda Oy, Helsinki, Finland.
Ann Hematol. 2022 Nov;101(11):2485-2495. doi: 10.1007/s00277-022-04959-9. Epub 2022 Sep 13.
Multiple myeloma (MM) patients are predominantly elderly with comorbidities that have an impact on patient mortality and treatment decisions. We previously reported the patient characteristics and overall survival outcomes of the Finnish MM cohort diagnosed between 2005 and 2016 in a nationwide retrospective registry study comprising 3,851 adults. Here, we report detailed comorbidity characteristics for this real-world Finnish MM population at cohort entry and during follow-up. Data on diagnoses and causes of death were obtained from Finnish healthcare data registries and interrogated using various multistate time-to-event models. In the year preceding MM diagnosis, comorbidities (as per Charlson Comorbidity Index definition) were recorded in 38.0% of the cohort, of which 27.9% presented with pre-existing cardiovascular disease (CVD) and 4.8% had suffered a major adverse cardiac event (MACE). At 2 years post-MM diagnosis, cumulative incidence for CVD and MACE more than doubled to 57.1% and 11.4%, respectively, and only 31.9% of the cohort remained CVD-free. Prevalent secondary malignancies were recorded in 16.8% of the patient population at MM diagnosis, with cumulative incidence increasing steadily to 27.5% at 2 years and 33% at 5 years post-diagnosis. The main cause of mortality attributed to MM, CVD, secondary malignancy, or other causes remained stable throughout the follow-up, at an average of 74.2%, 9.4%, 9.8%, and 6.5%, respectively. Prevalence of CVDs and secondary malignancies is high in Finnish patients at MM diagnosis, with older male patients suffering from higher MACE and mortality risk. Proper recording and management of comorbidities alongside novel treatments remain crucial for optimal MM management.
多发性骨髓瘤（MM）患者主要为老年患者，伴有影响患者死亡率和治疗决策的合并症。我们之前报道了在一项全国性回顾性注册研究中，2005 年至 2016 年间诊断的芬兰 MM 队列的患者特征和总生存结果，该研究纳入了 3851 名成年人。在这里，我们报告了该真实世界芬兰 MM 人群在队列入组时和随访期间的详细合并症特征。通过芬兰医疗保健数据登记处获取诊断和死亡原因的数据，并使用各种多状态时间事件模型进行查询。在 MM 诊断前 1 年，队列中有 38.0%的患者存在合并症（按 Charlson 合并症指数定义），其中 27.9%存在预先存在的心血管疾病（CVD），4.8%发生了重大不良心脏事件（MACE）。在 MM 诊断后 2 年，CVD 和 MACE 的累积发生率增加了一倍以上，分别为 57.1%和 11.4%，只有 31.9%的患者没有发生 CVD。在 MM 诊断时，患者人群中有 16.8%记录了常见的继发性恶性肿瘤，累积发生率稳步上升，2 年时达到 27.5%，5 年时达到 33%。导致死亡的主要原因是 MM、CVD、继发性恶性肿瘤或其他原因，在整个随访期间保持稳定，平均分别为 74.2%、9.4%、9.8%和 6.5%。芬兰 MM 患者的 CVD 和继发性恶性肿瘤患病率较高，年龄较大的男性患者发生 MACE 和死亡率的风险更高。在新型治疗的同时，对合并症进行适当的记录和管理仍然是 MM 管理的关键。
