title: Early mortality in multiple myeloma: Experiences from a single institution.
abstract: OBJECTIVE
  Multiple myeloma (MM) is a hematological malignancy that presents with infection, anemia, bone lesions, renal function impairment, and hypercalcemia. The survival of MM patients has improved in recent decades; however, early mortality remains a critical problem. The aim of this study was to identify the etiologies and clinical variables associated with early mortality in MM. In addition, the effects of bortezomib on reducing early mortality incidence were investigated.
  
  
  METHODS
  Medical records from 122 MM patients diagnosed between November 2007 and December 2013 were retrospectively reviewed. Early mortality was defined as death by any cause within the first 180 days after pathological diagnosis.
  
  
  RESULTS
  In newly diagnosed MM patients, early mortality occurred in 22.95% of patients. Infection accounted for 67.86% of early deaths. Multivariate analyses by Cox proportional-hazards regression showed that higher β2-microglobulin (P < 0.001) and serum lactate dehydrogenase (P < 0.001) levels, and lower serum albumin levels (P < 0.001) were associated with early mortality. Both first-line and greater than or equal to second-line bortezomib treatments were not associated with superior 180-day overall survival (P = 0.546 for first-line bortezomib treatment; P = 0.066 for greater than or equal to second-line bortezomib treatment).
  
  
  CONCLUSIONS
  Our results suggest that infection is the leading cause of early death in MM. High β2-microglobulin, high serum lactate dehydrogenase, and low serum albumin levels are poor prognostic factors for early mortality. Bortezomib therapy does not appear to reduce the incidence of early mortality in MM patients.
authors: a Division of Hematology/Medical Oncology, Department of Medicine , Taichung Veterans General Hospital , Taiwan.
authors: Yeh-Ku
authors: YK
authors: Chen
authors: a Division of Hematology/Medical Oncology, Department of Medicine , Taichung Veterans General Hospital , Taiwan.
authors: Shao-Min
authors: SM
authors: Han
authors: a Division of Hematology/Medical Oncology, Department of Medicine , Taichung Veterans General Hospital , Taiwan.|b School of Medicine, College of Medicine , China Medical University , Taiwan.
authors: Youngsen
authors: Y
authors: Yang
authors: a Division of Hematology/Medical Oncology, Department of Medicine , Taichung Veterans General Hospital , Taiwan.|c Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine , Taichung Veterans General Hospital , Taiwan.|d Department of Medicine , Chung Shan Medical University , Taiwan.
authors: Tseng-Hsi
authors: TH
authors: Lin
authors: a Division of Hematology/Medical Oncology, Department of Medicine , Taichung Veterans General Hospital , Taiwan.
authors: Huey-En
authors: HE
authors: Tzeng
authors: e Department of Medical Research and Education , Taichung Veterans General Hospital , Taiwan.
authors: Kuang-Hsi
authors: KH
authors: Chang
authors: a Division of Hematology/Medical Oncology, Department of Medicine , Taichung Veterans General Hospital , Taiwan.
authors: Wen-Li
authors: WL
authors: Hwang
authors: a Division of Hematology/Medical Oncology, Department of Medicine , Taichung Veterans General Hospital , Taiwan.|d Department of Medicine , Chung Shan Medical University , Taiwan.|f Department of Life Science , Tunghai University , Taiwan.
authors: Chieh-Lin Jerry
authors: CL
authors: Teng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000069286:Bortezomib / Q000008:administration & dosage; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D000069286:Bortezomib
keywords: Bortezomib; Mortality; Multiple myeloma