Impact of time period of diagnosis, race, and military exposures on the survival of US military veterans with multiple myeloma and/or plasmacytoma.

Abstract

e20061 Background: The aging veteran population represents a unique demographic with potential exposures to carcinogens. Multiple myeloma has been linked to exposure to Agent Orange, burn pits, radiation, and water contamination. There have been remarkable advances in the management of multiple myeloma. We investigate whether the survival of veterans diagnosed with multiple myeloma and/or plasmacytoma has changed over time. Methods: Using ICD-O criteria we identified 14,026 veterans diagnosed with multiple myeloma and/or plasmacytoma between 1/1/2000 and 12/31/2020 in the national electronic Veterans Administration (VA) medical records. Variables including age and date of diagnosis, race, gender, branch of military service, tobacco use, military exposures, cause of death and survival were analyzed. Patients were subdivided into 4 time periods for analysis based on date of diagnosis: Group 1 (1/1/2000-12/31/2005), Group 2 (1/1/2006-12/31/2010), Group 3 (1/1/2011-12/31/2015), Group 4 (1/1/2016-12/31/2020). Results: Of the 14,026 cases, 98% of patients were male, 58% were white and 28% black; 57% were current or previous tobacco users, 26% were never users. The table summarizes military exposures and causes of death. Median overall survival (OS) for Group 1 was 0.9 years [95% CI, 0.8-1], Group 2 was 2 years [95% CI, 1.8-2.9], Group 3 was 2.8 years [95% CI, 2.6-2.9], and Group 4 was 3.5 years [95% CI, 3.3-3.6]. These differences in OS were statistically significant (p<0.0001). Deaths attributed to myeloma accounted for 67%, 65%, 63%, and 56% of patients in Group 1, 2, 3, and 4, respectively. On multivariable analysis of 6023 cases where selected variables were consistently available, tobacco use, exposure to Agent Orange or burn pits, older age and earlier time period of diagnosis were significantly associated with shorter survival. However, race did not significantly impact survival. Conclusions: In US military veterans diagnosed with multiple myeloma and/or plasmacytoma, survival has significantly improved over the past two decades. Survival was adversely impacted by tobacco use and military exposures, but not impacted by race. Advances in diagnosis, therapies and supportive care may have contributed to the observed improvement in survival over time. Future research should investigate if differences exist in the pathophysiology of malignancies developing in veterans with military exposures, and whether novel treatments can improve their outcomes. [Table: see text]