Abstract
Longer survival in patients with multiple myeloma (MM) after treatment with novel agents (NA) such as thalidomide, bortezomib, and lenalidomide may be associated with increased risks of developing second primary malignancies (SPM). Few data describe the risk of SPM in patients with MM in Asia. This population-based retrospective cohort study assessed the risk of SPM in MM using the Taiwan National Cancer Registry and National Health Insurance Research databases from 2000 to 2014. Among 4,327 patients with newly diagnosed MM initiated with either novel agents alone (NA), chemotherapy combined with novel agents (CCNA), or chemotherapy alone (CA), the cumulative incidence of SPM overall was 1.33% at year 3. The SPM incidence per 100 person-years (95% confidence interval [CI]) was 0.914 (0.745–1.123) overall, 0.762 (0.609–1.766) for solid tumours, and 0.149 (0.090–0.247) for haematological malignancies. We compared risks of SPM using a cause-specific Cox regression model considering death as a competing risk for developing SPM. After controlling for age, gender, Charlson Co-morbidity Index, and time-period, the risk of developing any SPM or any haematological malignancy was significantly reduced in patients initiated on NA (2010–2014 period) compared to chemotherapy alone (adjusted hazard ratio 0.24, 95% CI 0.07–0.85, and 0.10, 95% CI 0.02–0.62, respectively). Contemporary treatment regiments using NA (mainly bortezomib) were associated with a lower risk for a SPM in comparison with CA.
Highlights
Multiple myeloma (MM) is clonal plasma cell malignancy that is heterogenous in its clinical presentation and progression
Using claims data from the National Health Insurance Research database (NHIRD) we showed that the unadjusted incidence of MM in Taiwan increased by 30% from 2007 to 2012, accompanied by a decrease in case fatality from 25.5 to 19.4% that coincided with the availability of novel agents for MM treatment in T aiwan[9]
A total of 23.7% of patients initiated treatment with novel agents alone, 21.9% initiated treatment with chemotherapy combined with novel agents, and 54.4% with chemotherapy alone
Summary
Multiple myeloma (MM) is clonal plasma cell malignancy that is heterogenous in its clinical presentation and progression It is more common in older age-groups and in men. Using claims data from the National Health Insurance Research database (NHIRD) we showed that the unadjusted incidence of MM in Taiwan increased by 30% from 2007 to 2012, accompanied by a decrease in case fatality from 25.5 to 19.4% that coincided with the availability of novel agents for MM treatment in T aiwan[9]. There are concerns that the incidence of SPM will increase as survival from MM improves In this retrospective cohort study, we conducted an in-depth study of SPMs in patients with MM, using the Taiwan Cancer Registry, covering the time period before and after the introduction of novel agents for first-line treatment of MM in Taiwan. We linked cancer registry data with patients’ treatment data from NHIRD claims data to evaluate the risk of SPM in patients who received different MM treatments for first-line therapy
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