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Am J Hematol. 2016 Jul;91(7):700-4. doi: 10.1002/ajh.24389. Epub 2016 Apr 28.

Early mortality in multiple myeloma: the time-dependent impact of comorbidity: A population-based study in 621 real-life patients.

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Monoclonal Gammopathies Unit, University Hospital Virgen De Las Nieves, Granada, Spain.
Department of Hematology, University Hospital Virgen De Las Nieves, Granada, Spain.
Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain.
Instituto De Investigación Biosanitaria De Granada (Ibs.GRANADA), Hospitales Universitarios De Granada/Universidad De Granada, Granada, Spain.
University Hospital 12 De Octubre, Madrid, Spain.
Granada Cancer Registry, Andalusian School of Public Health, Granada, Spain.
Department of Inmunology, University Hospital Virgen De Las Nieves, Granada, Spain.
CIBER Epidemiology and Public Health, Granada, Spain.
Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.


Multiple myeloma is a heterogeneous disease with variable survival; this variability cannot be fully explained by the current systems of risk stratification. Early mortality remains a serious obstacle to further improve the trend toward increased survival demonstrated in recent years. However, the definition of early mortality is not standardized yet. Importantly, no study has focused on the impact of comorbidity on early mortality in multiple myeloma to date. Therefore, we analyzed the role of baseline comorbidity in a large population-based cohort of 621 real-life myeloma patients over a 31-year period. To evaluate early mortality, a sequential multivariate regression model at 2, 6, and 12 months from diagnosis was performed. It was demonstrated that comorbidity had an independent impact on early mortality, which is differential and time-dependent. Besides renal failure, respiratory disease at 2 months, liver disease at 6 months, and hepatitis virus C infection at 12 months, were, respectively, associated with early mortality, adjusting for other well-established prognostic factors. On the other hand, the long-term monitoring in our study points out a modest downward trend in early mortality over time. This is the first single institution population-based study aiming to assess the impact of comorbidity on early mortality in multiple myeloma. It is suggested that early mortality should be analyzed at three key time points (2, 6, and 12 months), in order to allow comparisons between studies. Comorbidity plays a critical role in the outcome of myeloma patients in terms of early mortality. Am. J. Hematol. 91:700-704, 2016.

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