The effect of health co-morbidities on outcomes in patients with multiple myeloma.

Abstract

e19529 Background: Multiple Myeloma is a hematological malignancy that occurs when plasma cells become cancerous. Patients with multiple myeloma are typically above the age of 65 years and often have other pre-existing health comorbidities. Although some studies do show that such comorbidities are associated with decreased survival, information available on how these affect stage and risk status at diagnosis is limited. This study aims to understand how health comorbidities affect survival, stage, and risk status in patients with multiple myeloma. Methods: A list of 500 patients who had a listed plasma cell dyscrasia diagnosis was compiled. Patients with a confirmed ICD-10 diagnosis of multiple myeloma were included. MGUS and smoldering myeloma were excluded. 267 patients were included in the data analysis. Demographics and information on pre-existing comorbidities as well as survival status and stage and risk status at diagnosis were documented. The comorbidities included were atrial fibrillation, coronary artery disease (CAD), congestive heart failure (CHF), stroke, diabetes mellitus, chronic obstructive pulmonary disease (COPD), liver disease, chronic kidney disease (CKD), and other malignancies. Chi-square analysis and logistic regression analysis were done. P-value <0.05 was considered significant. Results: 53.2% of patients were 65 years or older. 46.8% were younger than 65 years. 55.4% identified as White, 33.4% as Black, 6.2% as Hispanic, and 5% as other races. Deceased patients were more likely to have CKD compared to alive patients (12.3% vs 4.0% p-value 0.026). Although the deceased patients had a higher percentage of each one of the listed comorbidities compared to the living patients, only CKD was considered statistically significant respective to survival status. Patients who had a higher risk of progression were more likely to have CKD compared to patients with standard risk (8.4% vs. 1.7% p-value 0.019). Patients who were high risk were also more likely to have atrial fibrillation (15.9% vs. 6.7% p-value 0.028). None of the other co-morbidities showed a statistically significant difference between the two risk categories. Patients in stage R-ISS stage III were more likely to have CKD compared to patients in stages I or II (11.0% vs. 1.4% p-value <0.001). The remaining comorbidities did not show a statistically significant difference in terms of stage at diagnosis. Conclusions: This data suggests that patients who had CKD as a comorbidity prior to diagnosis of multiple myeloma were more likely to have progression of disease and be diagnosed at a later stage. These patients may also have higher mortality. It is possible that the disease burden of CKD leads to delays in diagnosis of multiple myeloma and it is important for clinicians to gain a better of understanding of this to improve outcomes. This study was limited by lower power due to smaller sample size, but it emphasizes the need for further studies in this subject.