Multiple myeloma: routes to diagnosis, clinical characteristics and survival – findings from a <scp>UK</scp> population‐based study

Howell, Debra; Smith, Alexandra; Appleton, Simon; Bagguley, Timothy; Macleod, Una; Cook, Gordon; Patmore, Russell; Roman, Eve

doi:10.1111/bjh.14513

Cited by 44 publications

(46 citation statements)

References 13 publications

(16 reference statements)

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“…It is, however, challenging to compare the characteristics of the study population with those from other European population-based studies owing to differences in the parameters reported. 16,21 A relatively high proportion of patients scored III using the ISS at diagnosis compared with other studies, 16,21 although high ISS stages are associated with poor survival and would be expected in a population of now deceased patients. 22 Furthermore, only one-quarter of patients had a history of skeletal-related events; this is lower than would be expected because bone disease occurs in 80% of patients with newly diagnosed MM.…”

Section: Discussionmentioning

confidence: 94%

Understanding mortality in multiple myeloma: Findings of a European retrospective chart review

Mohty

Cavo²,

Fink³

et al. 2019

European J of Haematology

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ObjectivesThis study aimed to provide real‐world data on the characteristics and treatment of patients with multiple myeloma (MM) at the time of death.MethodsThe study was a retrospective patient chart review across France, Germany, Italy, Spain and the UK during 2016, and included patients who had died in the 3 months before the index date.ResultsData from 786 patients were reviewed. At the time of death, 37% of patients were receiving active treatment, 12% were in a treatment‐free interval and 51% were receiving only supportive care. Death before and during active first‐line treatment was not uncommon (6% and 24% of patients, respectively) but these deaths were often not solely due to disease progression; factors such as renal failure and infection frequently played a role (in 30% and 20% of patients at first‐line, respectively). Most deaths at later lines were due to progressive disease. Cox model results suggested that early deaths were associated with advanced disease stage, high‐risk cytogenetics and poor response and relapse profiles.ConclusionsThese real‐world data could be used to help develop strategies for improving survival in patients with MM and to support management tailored to the stage of disease.

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Section: Discussionmentioning

confidence: 94%

Understanding mortality in multiple myeloma: Findings of a European retrospective chart review

Mohty

Cavo²,

Fink³

et al. 2019

European J of Haematology

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“…The relationship between late diagnosis and poor outcome is recognised for many cancers, with delay often resulting in more advanced disease, worse survival, increased risk of complications, and impaired quality of life. [1][2][3] Hence, over recent decades the UK Department of Health has introduced a series of interventions aimed at facilitating earlier diagnosis. In primary care settings, this includes referral guidance to aid GP identification of cancer symptoms and the introduction of suspected cancer pathways to minimise time to specialist secondary care consultation.…”

Section: Introductionmentioning

confidence: 99%

Hodgkin lymphoma detection and survival: findings from the Haematological Malignancy Research Network

et al. 2019

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BackgroundHodgkin lymphoma is usually detected in primary care with early signs and symptoms, and is highly treatable with standardised chemotherapy. However, late presentation is associated with poorer outcomes.AimTo investigate the relationship between markers of advanced disease, emergency admission, and survival following a diagnosis of classical Hodgkin lymphoma (CHL).Design & settingThe study was set within a sociodemographically representative UK population-based patient cohort of ~4 million, within which all patients were tracked through their care pathways, and linked to national data obtained from Hospital Episode Statistics (HES) and deaths.MethodAll 971 patients with CHL newly diagnosed between 1 September 2004–31 August 2015 were followed until 18th December 2018.ResultsThe median diagnostic age was 41.5 years (range 0–96 years), 55.2% of the patients were male, 31.2% had stage IV disease, 43.0% had a moderate–high or high risk prognostic score, and 18.7% were admitted via the emergency route prior to diagnosis. The relationship between age and emergency admission was U-shaped: more likely in patients aged <25 years and ≥70 years. Compared to patients admitted via other routes, those presenting as an emergency had more advanced disease and poorer 3-year survival (relative survival 68.4% [95% confidence interval {CI} = 60.3 to 75.2] versus 89.8% [95% CI = 87.0 to 92.0], respectively [P<0.01]). However, after adjusting for clinically important prognostic factors, no difference in survival remained.ConclusionThese findings suggest that CHL survival as a whole could be increased by around 4% if the cancer in patients who presented as an emergency had been detected at the same point as in other patients.

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“…Among haematological cancers (lymphomas, myelomas and leukaemias), emergency presentation is relatively common [10], [11]. While this is clearly the appropriate route for conditions like the acute leukaemias, the reasons why a relatively large proportion of patients with non-Hodgkin lymphomas (NHL) present as an emergency and have poorer survival is less obvious.…”

Section: Introductionmentioning

confidence: 99%

Emergency admission and survival from aggressive non-Hodgkin lymphoma: A report from the UK's population-based Haematological Malignancy Research Network

Kane

Howell

Smith

et al. 2017

European Journal of Cancer

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BackgroundNon-Hodgkin lymphoma (NHL) is often diagnosed after emergency presentation, a route associated with poor survival and an indicator of diagnostic delay. Accounting for around half of all NHLs, diffuse large B-cell lymphoma (DLBCL) is of particular interest since although it is potentially curable with standardised chemotherapy it can be challenging to identify at an early stage in the primary care setting.Patients and methodsSet within a socio-demographically representative United Kingdom population of around 4 million people, data are from an established patient cohort. This report includes all patients (≥18 years) diagnosed with DLBCL 2004–2011 (n = 1660). Emergency admissions were identified via linkage to Hospital Episode Statistics using standard methods, and survival was examined using proportional hazards regression.ResultsTwo out of every five patients were diagnosed following an emergency admission, and this was associated with advanced disease and poor survival (p < 0.001). Among the 80% of patients treated with curative chemotherapy, survival discrepancies emerged at the point of diagnosis; the adjusted hazard ratio (emergency versus non-emergency) at one month being 4.0 (95% confidence interval 1.9–8.2). No lasting impact was evident in patients who survived for 12 months or more.ConclusionEmergency presentation impacts negatively on DLBCL survival; patients presenting via this route have significantly poorer outcomes than patients with similar clinical characteristics who present via other routes.

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Multiple myeloma: routes to diagnosis, clinical characteristics and survival – findings from a UK population‐based study

Cited by 44 publications

References 13 publications

Understanding mortality in multiple myeloma: Findings of a European retrospective chart review

Understanding mortality in multiple myeloma: Findings of a European retrospective chart review

Hodgkin lymphoma detection and survival: findings from the Haematological Malignancy Research Network

Emergency admission and survival from aggressive non-Hodgkin lymphoma: A report from the UK's population-based Haematological Malignancy Research Network

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