Second Primary Malignancy Risk in Multiple Myeloma from 1975 to 2018

Abstract

As the survival times for multiple myeloma (MM) patients continue to extend, the risk of a second primary malignancy (SPM) among MM survivors has become a topic of increasing concern within the medical community. The Surveillance, Epidemiology, and End Results (SEER) 9 Registry Database was used to evaluate the risk and survival of SPM among MM survivors from 1975 to 2018. The standardized incidence ratio (SIR), absolute excess risk (AER), and cumulative incidence (CMI) of SPM for MM risk were calculated. Survival and the CMI were estimated by using hazard ratios (HRs). Subgroup analyses were performed according to race, sex, age, time of myeloma diagnosis, and the SPM site. A total of 43,825 cases were recorded with the initial diagnosis of MM from 1975 to 2018. A total of 3101 (7.1%) patients developed 3407 SPMs. Solid tumors were decreased in patients with MM (SIR = 0.93; 95% CI = 0.90–0.97) compared to the general population, whereas the risk of hematological malignancy was increased (SIR = 1.90; 95% CI = 1.72–2.10). Taking death as a competing event, the CMI of SPM in the whole population was 7.38% at 10 years (6.11% solid and 1.27% hematologic). Factors associated with SPM occurrence were age, sex, race, and time of MM diagnosis. The survival of SPM patients from MM diagnosis was longer than that of patients without SPM (HR = 0.67, 95% CI = 0.58–0.63). The median survival time was 17 months from SPM diagnosis and 34 months from MM diagnosis (HR = 1.4, 95% CI = 1.35–1.46). Age, race, and sex were important factors for the risk of SPM. Site- and time-specific surveillance strategies should be recommended to monitor SPM in high-risk MM patients.

Outcome of Second Primary Malignancies Developing in Multiple Myeloma Patients

“…Interestingly, in contrast to their frequencies in the general population [22], but in line with prior studies that evaluated SPMs in patients with MM [23], the most common hemato-SPMs were AML and MDS rather than NHL [24,25], caused by the progression of occult BM clonal hematopoiesis(ref) and/or treatment-related toxicity, mainly AutoHCT [17].…”

Secondary Malignancies in Multiple Myeloma in Korean Patients: A Nationwide Population-Based Study

“…Among IMiDs, lenalidomide has been indicated consistently as a possible contributor to SPM development in several large-scale randomized studies and meta-analyses [5,[20][21][22][23][24]. In our research, in the same context, lenalidomide might be an attributable factor for SPM because lenalidomide had been introduced to the clinical practice with being covered by NHIS in Korea since the year 2014.…”

The Effects of Second Primary Malignancies and Frailty on Overall Survival and Mortality in Geriatric Turkish Patients with Multiple Myeloma

“…Turgutkaya et al showed five (1.6%) SPM cases among 310 symptomatic Turkish MM patients, and these patients had shorter survival [ 7 ]. Wang et al collected data from the SEER 9 Registry Database (1973–2018) on 43,825 newly diagnosed MM patients and found that a total of 3101 (7.1%) patients developed 3407 SPMs [ 28 ]. They also showed that age, race, sex, and time of diagnosis were significant factors for the risk of developing SPM, and that patients with SPM had a 1.4-fold higher risk of mortality.…”