title: The role of initial clinical presentation, comorbidity and treatment in multiple myeloma patients on survival: a detailed population-based cohort study.
abstract: OBJECTIVE
  This prospective, observational population-based cohort study was performed to determine overall survival (OS) in multiple myeloma (MM) patients in Friesland, the Netherlands, in the era of novel agents and to analyse the influence of first-line treatment, MM-related end-organ damage and comorbidities at initial presentation on OS.
  
  
  METHODS
  Detailed clinical information was obtained from the population-based registry 'HemoBase' during the period January 2005 to January 2013, with a follow-up to January 2014.
  
  
  RESULTS
  Overall, the symptomatic MM patients (n = 225) had a median OS of 40 months. In the age categories <65, 65-75 and ≥75 years, 99, 94 and 87% of the patients received treatment, with a median OS of 92, 42 and 31 months, respectively. OS for patients with or without treatment was 43 and 3 months, respectively. In multivariable analysis, risk factors for worse OS were increasing age (<65: reference; 65-75: HRadj.= 2.2 (95% CI 1.3-3.7) and ≥75: HRadj.= 2.8 (95% CI 1.7-4.8); P < 0.001), not receiving initial treatment (HRadj.= 4.0 (95% CI 2.1-7.7); P < 0.001), hypercalcaemia (P < 0.001, HRadj.= 1.7 (95% CI 1.2-2.6), P = 0.006) and impaired renal function (HRadj.= 2.6 (95% CI 1.7-4.0); P < 0.001).
  
  
  CONCLUSIONS
  Increasing age, not receiving initial treatment, hypercalcaemia and impaired renal function at initial presentation were independent risk factors for worse OS. Comorbidity according to Charlson comorbidity index score was not an independent variable predicting OS.
authors.affiliation: Department of Clinical Pharmacy & Pharmacology, Medical Centre Leeuwarden, Leeuwarden, PO Box 888, 8901 BR Leeuwarden, The Netherlands. Berdien.Oortgiesen@znb.nl.
authors.forename: B E
authors.initials: BE
authors.lastname: Oortgiesen
authors.affiliation: Department of Clinical Pharmacy & Pharmacology, Medical Centre Leeuwarden, Leeuwarden, PO Box 888, 8901 BR Leeuwarden, The Netherlands.|Unit of Pharmacotherapy, Epidemiology and Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
authors.forename: E N
authors.initials: EN
authors.lastname: van Roon
authors.affiliation: Department of Haematology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Joosten
authors.affiliation: Department of Pathology, Pathology Friesland, Leeuwarden, The Netherlands.
authors.forename: R E
authors.initials: RE
authors.lastname: Kibbelaar
authors.affiliation: Department of Clinical Chemistry, Medical Centre Leeuwarden CERTE KCL, Leeuwarden, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Storm
authors.affiliation: Department of Haematology, Nij Smellinghe, Drachten, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Hovenga
authors.affiliation: Department of Haematology, Antonius Hospital, Sneek, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: van Rees
authors.affiliation: Department of Haematology, Tjongerschans, Heerenveen, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Woolthuis
authors.affiliation: Department of Epidemiology, MCL Academy, Leeuwarden, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Veeger
authors.affiliation: Department of Haematology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: E G
authors.initials: EG
authors.lastname: de Waal
authors.affiliation: Department of Haematology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Hoogendoorn
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006934:Hypercalcemia / Q000150:complications / Q000453:epidemiology*; D007674:Kidney Diseases / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000473:pathology; D015999:Multivariate Analysis; D009426:Netherlands; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents
keywords: Clinical parameters; Multiple myeloma; Novel agents; Overall survival; Population-based registry