title: Early mortality in multiple myeloma: the time-dependent impact of comorbidity: A population-based study in 621 real-life patients.
abstract: Multiple myeloma is a heterogeneous disease with variable survival; this variability cannot be fully explained by the current systems of risk stratification. Early mortality remains a serious obstacle to further improve the trend toward increased survival demonstrated in recent years. However, the definition of early mortality is not standardized yet. Importantly, no study has focused on the impact of comorbidity on early mortality in multiple myeloma to date. Therefore, we analyzed the role of baseline comorbidity in a large population-based cohort of 621 real-life myeloma patients over a 31-year period. To evaluate early mortality, a sequential multivariate regression model at 2, 6, and 12 months from diagnosis was performed. It was demonstrated that comorbidity had an independent impact on early mortality, which is differential and time-dependent. Besides renal failure, respiratory disease at 2 months, liver disease at 6 months, and hepatitis virus C infection at 12 months, were, respectively, associated with early mortality, adjusting for other well-established prognostic factors. On the other hand, the long-term monitoring in our study points out a modest downward trend in early mortality over time. This is the first single institution population-based study aiming to assess the impact of comorbidity on early mortality in multiple myeloma. It is suggested that early mortality should be analyzed at three key time points (2, 6, and 12 months), in order to allow comparisons between studies. Comorbidity plays a critical role in the outcome of myeloma patients in terms of early mortality. Am. J. Hematol. 91:700-704, 2016. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Monoclonal Gammopathies Unit, University Hospital Virgen De Las Nieves, Granada, Spain.|Department of Hematology, University Hospital Virgen De Las Nieves, Granada, Spain.|Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain.|Instituto De Investigación Biosanitaria De Granada (Ibs.GRANADA), Hospitales Universitarios De Granada/Universidad De Granada, Granada, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Ríos-Tamayo
authors.affiliation: Monoclonal Gammopathies Unit, University Hospital Virgen De Las Nieves, Granada, Spain.|Department of Hematology, University Hospital Virgen De Las Nieves, Granada, Spain.|Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain.|Instituto De Investigación Biosanitaria De Granada (Ibs.GRANADA), Hospitales Universitarios De Granada/Universidad De Granada, Granada, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Sáinz
authors.affiliation: University Hospital 12 De Octubre, Madrid, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Martínez-López
authors.affiliation: Department of Hematology, University Hospital Virgen De Las Nieves, Granada, Spain.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Puerta
authors.affiliation: Instituto De Investigación Biosanitaria De Granada (Ibs.GRANADA), Hospitales Universitarios De Granada/Universidad De Granada, Granada, Spain.|Granada Cancer Registry, Andalusian School of Public Health, Granada, Spain.
authors.forename: Daysi-Yoe-Ling
authors.initials: DY
authors.lastname: Chang
authors.affiliation: Department of Inmunology, University Hospital Virgen De Las Nieves, Granada, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Rodríguez
authors.affiliation: Department of Hematology, University Hospital Virgen De Las Nieves, Granada, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Garrido
authors.affiliation: Department of Inmunology, University Hospital Virgen De Las Nieves, Granada, Spain.
authors.forename: José Luís García
authors.initials: JL
authors.lastname: de Veas
authors.affiliation: Department of Hematology, University Hospital Virgen De Las Nieves, Granada, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Romero
authors.affiliation: Department of Hematology, University Hospital Virgen De Las Nieves, Granada, Spain.
authors.forename: Lucía
authors.initials: L
authors.lastname: Moratalla
authors.affiliation: Department of Hematology, University Hospital Virgen De Las Nieves, Granada, Spain.
authors.forename: Elisa
authors.initials: E
authors.lastname: López-Fernández
authors.affiliation: Department of Hematology, University Hospital Virgen De Las Nieves, Granada, Spain.
authors.forename: Pedro Antonio
authors.initials: PA
authors.lastname: González
authors.affiliation: Instituto De Investigación Biosanitaria De Granada (Ibs.GRANADA), Hospitales Universitarios De Granada/Universidad De Granada, Granada, Spain.|Granada Cancer Registry, Andalusian School of Public Health, Granada, Spain.|CIBER Epidemiology and Public Health, Granada, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Sánchez
authors.affiliation: Instituto De Investigación Biosanitaria De Granada (Ibs.GRANADA), Hospitales Universitarios De Granada/Universidad De Granada, Granada, Spain.|CIBER Epidemiology and Public Health, Granada, Spain.|Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.
authors.forename: José Juan
authors.initials: JJ
authors.lastname: Jiménez-Moleón
authors.affiliation: Monoclonal Gammopathies Unit, University Hospital Virgen De Las Nieves, Granada, Spain.|Department of Hematology, University Hospital Virgen De Las Nieves, Granada, Spain.|Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain.|Instituto De Investigación Biosanitaria De Granada (Ibs.GRANADA), Hospitales Universitarios De Granada/Universidad De Granada, Granada, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Jurado
authors.affiliation: University Hospital 12 De Octubre, Madrid, Spain.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Lahuerta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015897:Comorbidity; D006801:Humans; D008875:Middle Aged; D009101:Multiple Myeloma / Q000453:epidemiology* / Q000401:mortality; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult