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Comorbidity characteristics of multiple myeloma patients diagnosed in Finland 2005-2016
Our recent RWE study detailed the comorbidity burden of Finnish multiple myeloma (MM) patients diagnosed between 2005 and 2016. Cardiovascular diseases (CVDs) and secondary malignancies were the most common groups of comorbid diseases and recorded as the main cause of death in c. 19% of cases during the follow-up. This publication (Toppila et al., 2022) represents a continuation work of our previously published study (Toppila et al., 2021), which outlined the patient characteristics and survival outcomes of this study population. The study was carried out by the experts at Takeda Oy, Medaffcon Oy, Helsinki University Hospital, and Helsinki University.
Multiple myeloma is a hematologic cancer predominantly affecting the elderly, with median age at diagnosis 70 years. Many MM patients are affected by significant comorbidities such as CVDs and secondary malignancies that impact both treatment decisions and ultimately patient mortality. The study utilized national healthcare registries to collate diagnoses and cause-of-death data, which were interrogated using various multistate time-to-event models. Comorbidities were defined according to recorded specialty care diagnoses and grouped according to the Charlson comorbidity index (CCI) definitions with minor modifications, to provide a robust comparison to past and future studies.
In the year preceding MM diagnosis, nearly all patients had records of specialty care visits. CCI-defined comorbidities were recorded for 38% of the cohort within this timeframe, with 27.9% presenting with CVDs, 4.8% having suffered a major adverse cardiac event (MACE) and 16.8% presenting with secondary malignancies at diagnosis. Cumulative incidence of recorded comorbidities further increased after MM diagnosis, with CVD and MACE incidence more than doubling to 57.1% and 11.4% in 2 years, respectively, whilst secondary malignancy nearly doubled to 33% in 5 years post MM diagnosis in the surviving study population. MM remained the main cause of death throughout the study (between 70.2-74.4%), with CVDs and secondary malignancies accounting for 9-12% of main causes of death each.
Our analyses showed that older MM male patients were had an increased risk for MACE, secondary malignancies and death. The study also confirmed that the overall comorbidity burden in MM patients is high, with many comorbidities recorded after MM diagnoses. This increased incidence may reflect an improved focus on sufficient comorbidity management post MM diagnosis to support optimal MM treatment.