Multiple myeloma is a heterogeneous hematological malignancy in which epidemiology plays an increasingly important role. In recent years, an unprecedented intensive research, including both clinical and molecular epidemiology, has deepened the knowledge about its pathogenesis, risk factors, and prognostic factors, leading also to the approval of new drugs. Although the etiology remains largely unknown, among the confirmed risk factors, only obesity and the exposure to certain carcinogens are potentially preventable. Familial myeloma and occupational myeloma are topics of great interest. Most population-based cancer registries show a stable incidence or only a slight trend to increase. The diagnostic delay should be avoided as much as possible. Mortality rates, including early mortality, are progressively decreasing, although infection remains the leading cause of mortality. The outcome in terms of overall survival and health-related quality of life has remarkably improved, joining the group of potentially curable malignancies. Nowadays the clinical scenario is challenging. Clinical and epidemiological variables of interest should be standardized in clinical records. Patients should be included in a population-based registry network. The clinical coordination of a multidisciplinary team in a specialized unit is needed in order to maximize the outcome of every patient.
Background: Multiple myeloma (MM) is characterized by osteolytic bone disease which is present in 70%>80% of patients at diagnosis, increasing the risk of skeletal-related events. The initial clinical presentation in MM has been associated with overall survival (OS) (Greenberg AJ et al.2013) showing that bone disease-only as myeloma-defining event (MDE) had good outcome. However, a subgroup of patients with bone disease having pathologic fracture (PF) as the initial clinical presentation may have poorer OS and they are the focus of the study. Aims: To assess the prognostic impact of PF as the initial MDE in newly diagnosed MM (NDMM) patients (pts). Methods: All NDMM pts with PF as the MDE have been selected from the Granada population-based MM Registry (Ríos-Tamayo R et al.2015). The epidemiologic, clinical and cytogenetic baseline prognostic variables have been analyzed. Progression free-survival (PFS) and OS curves were estimated in months (m) by the Kaplan-Meier method and compared with the log-rank test. Comparisons for categorical variables among different groups were made with the x 2 -test. Comparisons of means of quantitative continuous variables between two groups were made with the t-test. Results: Until the end of 2018, 505 NDMM pts included in our registry had the information about their MDE. 35 of them (6.93 %) showed a PF as their MDE. Pts with PF at clinical presentation had a statistically significant poorer median OS [21.3; 95% confidence interval (95% CI), 7.8-34.8 versus 38.5 m; 95% CI, 30.3-46.7; p = 0.036] (Figure 1). The median PFS were 14;95% CI, 5.5-22.5 versus 21 m; 95% CI, 16.5-25.5; p = ns. No statistically differences between groups were detected for age, sex, ISS3, High Risk FISH, serum creatinine, diagnostic delay, bone marrow plasma cells or weight loss. In the PF group there was a trend to high mean LDH (347.6 versus 263.4; p = 0.068), lower mean BMI (26.4 versus 28.2; p = 0.056) and higher percentage of ECOG4 (18.5% versus 5.6%; p = 0.096). Summary/Conclusion:Despite the characteristic finding of bone disease, the presence of PF as MDE is only detected in approximately 7% of NDMM pts. This specific clinical presentation is associated with a trend to present more clinical aggressiveness evidenced by higher LDH and higher percentage of ECOG4, conditioning finally worse OS.
× 10^6/kg after the first or second apheresis. The stem cell harvest were performed processing 2.5 − 3 times total blood volume. After collection, the patients received single or double course of melphalan 200 mg/m 2 or 1 course of melphalan 140 mg/m 2 according to local guideline. The minimal CD34+ number to perform a single HDC was 2x106/kg.Results: Patient characteristics are listed in Table 1. All patients but 2 (3%) achieved the target to perform the planned HCD. Median total CD34+ × 10 6 /kg harvested was 8.6. The proportion of patients able to achieve the goal with one apheresis was 50%. Only 1 patient underwent a third apheresis. Nine patients (14%) received plerixafor, 7 on day +4 and 2 on day +5. Median blood CD34+/mcl on day+4 and +5 was 33.5 (15-98), and 63 (10-171), respectively. Median total blood leucocyte counts (10^3/mm^3) on day 4+ and on day +5 was 41310 and 49250, respectively. Median CD34+ × 10 6 /kg in the first and second apheresis was 6.4 (0,8-16) and 4.7 (1.5-8), respectively. Median total leucocyte count (10 6 ) in the graft on first and second apheresis was respectively 71280 and 49250. After HDC, all patients but one experienced engraftment. Summary/Conclusion: GCSF alone stem cell mobilization is an effective and safe approach after induction in MM patients candidate to HDC. The main advantages are the possibility to predict peak CD34+ level (4-5 days), to schedule apheresis in an outpatient program and to avoid unnecessary toxicity with chemotherapy.
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