Large registry analysis to accurately define second malignancy rates and risks in a well-characterized cohort of 744 consecutive multiple myeloma patients followed-up for 25 years
Monika Engelhardt,
Gabriele Ihorst,
Ola Landgren,
Milena Pantic,
Heike Reinhardt,
Johannes Waldschmidt,
Annette M. May,
Martin Schumacher,
Martina Kleber,
Ralph Wäsch
Affiliations
Monika Engelhardt
Department of Hematology and Oncology, University of Freiburg Medical Center, Germany
Gabriele Ihorst
Center of Clinical Trials, University Medical Center Freiburg, Germany
Ola Landgren
Myeloma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
Milena Pantic
Department of Hematology and Oncology, University of Freiburg Medical Center, Germany
Heike Reinhardt
Department of Hematology and Oncology, University of Freiburg Medical Center, Germany
Johannes Waldschmidt
Department of Hematology and Oncology, University of Freiburg Medical Center, Germany
Annette M. May
Pathology Department, University of Freiburg, Germany
Martin Schumacher
Department of Medical Biometry and Statistics (IMBI), University of Freiburg, Germany
Martina Kleber
Department of Hematology and Oncology, University of Freiburg Medical Center, Germany
Ralph Wäsch
Department of Hematology and Oncology, University of Freiburg Medical Center, Germany
Additional malignancies in multiple myeloma patients after first-line and maintenance treatment have been observed, questioning whether specific risks exist. Second primary malignancies have also gained attention since randomized data showed associations to newer drugs. We have conducted this large registry analysis in 744 consecutive patients and analyzed: 1) frequency and onset of additional malignancies; and 2) second primary malignancy- and myeloma-specific risks. We assessed the frequency of additional malignancies in terms of host-, myeloma- and treatment-specific characteristics. To compare these risks, we estimated cumulative incidence rates for second malignancies and myeloma with Fine and Gray regression models taking into account competing risks. Additional malignancies were found in 118 patients: prior or synchronous malignancies in 63% and subsequent in 37%. Cumulative incidence rates for second malignancies were increased in IgG-myeloma and decreased in bortezomib-treated patients (P
