The Singapore Myeloma Study Group Consensus Guidelines for the management of patients with multiple myeloma

S, de Mel; Sk, Gopalakrishnan; Ooi, Melissa; C, Teo; D, Tan; Ml, Teo; Ac, Tso; Lee, Linda Yin King; Nagarajan, Chandramouli; Yt, Goh; Wj, Chng

doi:10.11622/smedj.2016150

Cited by 6 publications

(4 citation statements)

References 90 publications

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“…The utilization patterns observed in this study align with the recommendations outlined in the Singapore Myeloma Study Group Guidelines for managing multiple myeloma patients [14]. These guidelines predominantly advocate for proteasome inhibitor-based therapies, as they offer superior response rates and improved survival outcomes, alongside the use of thalidomide, melphalan, lenalidomide, and cyclophosphamide [14]. In comparison to cost estimates from other countries, the monthly cost per patient for therapy medications alone in Singapore is higher than those reported in China [15], The Netherlands [16], and Germany [17], but considerably lower than the costs in the United States [18,19], which are nearly double.…”

Section: Discussionsupporting

confidence: 74%

Section: Discussionsupporting

confidence: 62%

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Real‐world utilization and healthcare costs for multiple myeloma: A retrospective analysis of patients in Singapore

Bayani,

Lin,

Ooi

et al. 2023

eJHaem

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Multiple myeloma, a hematological malignancy, imposes a significant financial burden on healthcare systems. Health technology assessments (HTA) and economic evaluations play vital roles in reimbursement decisions and cost containment. This study aimed to explore healthcare utilization patterns and costs among myeloma patients in Singapore through a retrospective analysis of 605 patients treated at two cancer centers. Data encompassing demographics, treatment utilization, and billing were extracted from electronic records, and a cost analysis was performed from the perspective of the Singapore healthcare system. The results revealed common usage of immunomodulatory agents (52%) and proteasome inhibitors (37%), with bortezomib being the most frequently used targeted treatment. Treatment costs increased with disease progression, displaying variations depending on the therapeutic agent used. Notably, hospitalization costs due to adverse events were substantial, with pneumonia as the leading cause. This study highlights the high cost of myeloma therapy in Singapore, posing a financial burden for households. Findings may inform economic evaluations, evidence generation, reimbursement, and subsidy decisions. Leveraging real‐world data from electronic records provides valuable insights into local healthcare utilization patterns. Future studies may explore integrating billing databases with clinical repositories for a more comprehensive analysis, and consider limitations such as incomplete clinical information and potential selection bias.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionsupporting

confidence: 62%

Real‐world utilization and healthcare costs for multiple myeloma: A retrospective analysis of patients in Singapore

Bayani,

Lin,

Ooi

et al. 2023

eJHaem

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“…84 MELD exception points have been allowed for select patients with at least moderate POPH, who have been responsive to medical therapy. 85 However, a considerable number of patients that are incorrectly diagnosed with POPH receive MELD exception points. 86 Determination of the transpulmonary gradient can help distinguish pulmonary venous hypertension from POPH.…”

Section: Pulmonary Complications Of Clfhepatopulmonary Syndrome and Portopulmonary Hypertensionmentioning

confidence: 99%

Potentially inappropriate liver transplantation in the era of the “sickest first” policy – A search for the upper limits

Linecker

Krones

Berg

et al. 2018

Journal of Hepatology

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Liver transplantation has emerged as a highly efficient treatment for a variety of acute and chronic liver diseases. However, organ shortage is becoming an increasing problem globally, limiting the applicability of liver transplantation. In addition, potential recipients are becoming sicker, thereby increasing the risk of losing the graft during transplantation or in the initial postoperative period after liver transplantation (three months). This trend is challenging the model for end-stage liver disease allocation system, where the sickest candidates are prioritised and no delisting criteria are given. The weighting of the deontological demand for "equity", trying to save every patient, regardless of the overall utility; and "efficiency", rooted in utilitarianism, trying to save as many patients as possible and increase the overall quality of life of patients facing the same problem, has to be reconsidered. In this article we are aiming to overcome the widespread concept of futility in liver transplantation, providing a definition of potentially inappropriate liver transplantation and giving guidance on situations where it is best not to proceed with liver transplantation, to decrease the mortality rate in the first three months after transplantation. We propose "absolute" and "relative" conditions, where early post-transplant mortality is highly probable, which are not usually captured in risk scores predicting post-transplant survival. Withholding liver transplantation for listed patients in cases where liver transplant is not deemed clearly futile, but is potentially inappropriate, is a far-reaching decision. Until now, this decision had to be discussed extensively on an individual basis, applying explicit communication and conflict resolution processes, since the model for end-stage liver disease score and most international allocation systems do not include explicit delisting criteria to support a fair delisting process. More work is needed to better identify cases where transplantation is potentially inappropriate and to integrate and discuss these delisting criteria in allocation systems, following a societal debate on what we owe to all liver transplant candidates.

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“…Rising incidence of MM in Asia has been reported, and there are approximately 100 newly diagnosed cases per year in Singapore [ 15 , 16 ]. Given the drastic changes of treatment approach and increasing access to novel agents in our daily practice, it is important to study the natural history of first relapsed MM in a real-world setting.…”

Section: Introductionmentioning

confidence: 99%

Natural History and Prognostic Factors at First Relapse in Multiple Myeloma

Wang

Soekojo

Mel

et al. 2020

Cancers

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The prognosis of multiple myeloma has considerably improved due to the introduction of novel agents in the upfront setting. However, the great majority of patients ultimately relapse, and choosing a salvage treatment at first relapse remains challenging. The natural history of first relapsed disease in the current era is also not well described. We retrospectively studied 300 patients with first relapsed myeloma seen between 2004 and 2019 from two institutes in Singapore. The median duration from diagnosis to first relapse was 22.7 months (1.1–97.0 months). Most patients received novel agent-based induction therapy, and 41.3% underwent autologous stem cell transplant. A very good partial response (VGPR) or better was achieved in 48.6%. Regarding first relapse, 50.5% were symptomatic and 19.0% received newer agent-containing regimens. Nearly a third of patients (31.7%) had a VGPR or better response. The median progression free and overall survival from first relapse was 12.0 and 44.8 months, respectively. Based on a randomized sample splitting, we first identified non-hyperdiploid karyotype at diagnosis, clinical relapse, and treatment sequence as impacting survival independently from a testing cohort, and we then further demonstrated their significance in a validation cohort. This study provides a real-world picture of first relapsed myeloma and highlights the prognostic importance of the treatment sequence.

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The Singapore Myeloma Study Group Consensus Guidelines for the management of patients with multiple myeloma

Cited by 6 publications

References 90 publications

Real‐world utilization and healthcare costs for multiple myeloma: A retrospective analysis of patients in Singapore

Real‐world utilization and healthcare costs for multiple myeloma: A retrospective analysis of patients in Singapore

Potentially inappropriate liver transplantation in the era of the “sickest first” policy – A search for the upper limits

Natural History and Prognostic Factors at First Relapse in Multiple Myeloma

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