History of autoimmune disease is associated with impaired survival in multiple myeloma and monoclonal gammopathy of undetermined significance: a population-based study.
Multiple myeloma (MM) is a plasma cell disorder preceded by monoclonal gammopathy of undetermined significance (MGUS). Incidence of MM and MGUS is higher among patients with autoimmune disease. The aim of this study was to determine whether a history of autoimmunity has an impact on survival in MM and MGUS. Using high-quality national Swedish registries, we identified 8367 patients with MM, 18,768 patients with MGUS, and 110,251 matched control subjects, and obtained information on previous autoimmune disease in patients and controls. Cox regression was used to calculate hazard ratios (HRs) for overall survival with 95 % confidence intervals (CIs). In patients with MM and a prior autoimmune disease, the risk of death was significantly increased, HR = 1.2 (95 % CI 1.2-1.3) compared to MM patients with no history of autoimmunity. In MGUS patients, a prior autoimmune disease was associated with a significantly 1.4-fold elevated risk of death (95 % CI 1.3-1.4). When analyzing different types of autoimmune diseases, a history of ulcerative colitis had a stronger impact on survival in MM than in controls. Our findings that a history of autoimmune disease has a negative impact on survival in MM and MGUS could be due to shared underlying common genetic factors, or that patients with a history of autoimmunity develop more severe cases of MM and MGUS, or cumulative comorbidity in the individual. Our results suggest that more attention should be paid to comorbidity as a prognostic factor in MGUS and MM, and underlines the need for studies aimed at tailoring therapy according to comorbidity.
Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, 171 76, Stockholm, Sweden. ebba.lindqvist@ki.se.
Ebba K
EK
Lindqvist
Department of Medicine, Myeloma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Ola
O
Landgren
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Sigrún H
SH
Lund
Department of Hematology and Coagulation Disorders, Skåne University Hospital, Malmö, Sweden.
Ingemar
I
Turesson
Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, 171 76, Stockholm, Sweden.|Department of Medicine, Myeloma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Malin
M
Hultcrantz
Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA.
Lynn
L
Goldin
Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, 171 76, Stockholm, Sweden.
Magnus
M
Björkholm
Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, 171 76, Stockholm, Sweden.|Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Sigurdur Y
SY
Kristinsson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008998:Monoclonal Gammopathy of Undetermined Significance / Q000175:diagnosis / Q000401:mortality*; D009101:Multiple Myeloma / Q000175:diagnosis / Q000401:mortality*; D011159:Population Surveillance; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology
Autoimmunity; MGUS; Multiple myeloma; Population-based; Survival