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Abstract
The incidence of multiple myeloma (MM) is increasing worldwide, but the rate of increase is greatest in Asia. Few data describe the epidemiology and treatment of MM in Asia. Building on a cohort study from 2007 to 2012 using the Taiwan National Healthcare Insurance Research database, we extended our analysis to estimate the disease burden and treatment patterns of patients with MM in Taiwan through 2015. A further 1664 patients with newly diagnosed MM from 2013 to 2015 (total 4387 patients from 2007 to 2015) were enrolled and followed up until death or end of the observation period (December 31, 2016), whichever occurred first. The age distribution of the 2013–2015 cohort was similar to that for previous years, but there were fewer men (52.1% versus 58.0%), and more patients had renal impairment at diagnosis (19.7% versus 16.4%). From 2007 to 2015, crude annual incidences per 100,000 population of newly diagnosed MM increased from 1.74 to 2.48 and age-adjusted incidences from 1.41 to 1.65. Crude all-cause mortality rates increased over time. Case fatality decreased from 25.5 to 18.3% and median survival increased from 2.10 to 3.12 years. From 2007 to 2015, the percentage of patients receiving first-line therapy with novel agents increased from 0.4 to 89.4%, autologous stem cell transplantation doubled, and chemotherapy use decreased by 81%. Comprehensive national data covering 9 years of follow-up demonstrate continuing change in the disease burden, treatment, and survival of MM in Taiwan. Despite increased use of new treatments, MM remains largely incurable.
Highlights
Multiple myeloma (MM) is an incurable malignancy of clonal plasma cells that is associated with older age and is more common in men [1]
The use of chemotherapy alone for the first-line treatment of MM virtually ceased over the observation period, from 70.7% of patients in 2007 to 0.9% in 2015 (Fig. 5)
Novel agents used alone or with chemotherapy were used increasingly from 2009, such that by 2015, 89.4% of all patients with newly diagnosed MM received first-line therapy with a novel agent. The results of this extended analysis build on our previous study and confirm a continued increase in the disease burden due to MM in Taiwan since 2007 that as yet shows no sign of plateauing
Summary
Multiple myeloma (MM) is an incurable malignancy of clonal plasma cells that is associated with older age and is more common in men [1]. It is the second most common hematological malignancy after lymphoma, with a global agestandardized incidence in 2016 of 2.1 per 100,000 persons (95% confidence interval [CI] 1.8–2.3) and an agestandardized death rate of 1.5 per 100,000 persons (95% CI 1.3–1.7) [2]. Janssen Research & Development Epidemiology, 319 DunHua South Road, Taipei City 10669, Taiwan. The factors underlying the lower incidence of MM in Asia and contributing to its increase are not known
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