COMPARATIVE ANALYSIS OF COMORBIDITY INDICES WITH MULTIPLE MYELOMA
Abstract
A retrospective analysis of case histories of 206 patients with MM was performed in the hematology department of the City Hematology Center of Novosibirsk from 2006 to 2016. The median age for the group of patients younger than 65 years was 56.6 years (from 29 to 64 years) and 70.2 years (from 65 to 82) in the group of elderly patients. For each patient, a spectrum of associated diseases was determined at the time of initiation of therapy, and individual comorbidity indices were calculated according to the CIRS-G, M. Charlson and Fraiburg scales. Analysis of the data obtained showed that comorbidity is important in predicting OM in patients with MM. Of the comorbidity indices under study, Fraiburg index is the most important in predicting survival (HR – 3.870, p<0.003), since all of its factors, such as GFR ≤ 30 ml/min/1.73 m2 (HR-1,910 (95% CI 1,217 3.415) p<0.014), general condition on the Karnofsky scale ≤70 (HR-1.863 (95% CI 1,267-2.845) p<0.003), moderate or severe obstructive pulmonary disease (HR-1.845 (95% CI 1.165-3.235) p<0.004) showed a significant effect on the RH of patients with MM. The CIRS-G and M. Charlson indices did not have an independent prognostic value for MM in routine clinical practice. Cox regression analysis showed that of all associated diseases that are part of CIRS-G (14 organs and systems) and M. Charlson (19 associated diseases), only rhythm and conduction disorder (HR-1,580, p<0.003), chronic pancreatitis (HR-2,210, p<0.013) and obesity (HR-1.783, p<0.042) are significant factors affecting the RV in patients with MM.
References
1. Менделеева Л.П., Вотякова О.М., Покровская О.С. и др. Национальные клинические рекомендации по диагностике и лечению множественной миеломы. // Гематология и трансфузиология 2016. Т. 61. №1. Прил. 2. С. 1–24.
2. Kyle R.A., Rajkumar S.V. Epidemiology of the plasma-cell disorders. // Best Pract Res Clin Haematol. 2007. Vol. 20(4). P. 637–64. DOI:10.1016/j.beha.2007.08.001.
3. Waxman A.J., Mink P.J., Devesa S.S., et al. Racial disparities in incidence and outcome in multiple myeloma: apopulation-based study. // Blood. 2010. Vol. 116 (25). P. 5501–5506. DOI: 10.1182/ blood-2010-07-298760.
4. Crusoe Ede Q., da Silva A.M., Agareno J., et al. Multiple myeloma: a rare case in an 8-year-old child. // Clin Lymphoma Myeloma Leuk. 2015. Vol. 15(1). P. e31–e3. DOI: 10.1016/j. clml.2014.08.004.
5. Kristinsson S.Y., Landgren O., Dickman P.W., Derolf A.R., Björkholm M. Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. // J Clin Oncol. 2007. Vol. 25(15). P. 1993-1999.
6. Brenner H., Gondos A., Pulte D. Recent major improvements in long-term survival of younger patients with multiple myeloma. // Blood. 2008. Vol. 111(5). P. 2521-2526.
7. Schaapveld M., Visser O., Siesling S., et al. Improved survival among younger but not among older patients with multiple myeloma in the Netherlands, a population-based study since 1989. // Eur J Cancer. 2010. Vol. 46(1). P. 160-169.
8. Kumar S.K., Rajkumar S.V., Dispenzieri A., et al. Improved survival in multiple myeloma and the impact of novel therapies. // Blood. 2008. Vol. 111(5). P. 2516-2520.
9. Altekruse S.F., Kosary C.L., Krapcho M., et al., editors. SEER Cancer Statistics Review. Bethesda, MD: National Cancer Institute; 1975-2007. http://seer.cancer.gov/csr/1975_2007/, based on November 2009 SEER data submission, posted to the SEER Web site 2010.
10. Kristinsson S.Y., Landgren O., Dickman P.W., et al. Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. // J Clin Oncol. 2007. Vol. 25(15). P. 1993-1999.
11. Brenner H., Gondos A., Pulte D. Recent major improvements in long-term survival of younger patients with multiple myeloma. // Blood. 2008. Vol. 111(5). P. 2521-2526.
12. Hallek M., Fischer K., Fingerle-Rowson G., et al. Addition of rituximab to fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a randomised, open-label, phase 3 trial. // The Lancet. 2010. Vol. 376(9747). P. 1164–74. DOI: 10.1016/S0140-6736(10)61381-5.
13. Yancik R. Cancer burden in the aged: an epidemiologic and demographic overview. // Cancer. 1997. Vol. 80(7). P. 1273–83. DOI: 10.1002/(sici)10970142(19971001)80:7<1273::aid-cncr13>3.0.co;2-4.
14. Kleber M., Ihorst G., Terhorst M., et al. Comorbidity as a prognostic variable in multiple myeloma: comparative evaluation of common comorbidity scores and use of a novel MM–comorbidity score. // Blood Cancer J. 2011. Vol. 1(9). P. e35.
15. Sung Min Kim, Moon Jin Kim, Hyun Ae Jung, et al. Comparison of the Freiburg and Charlson Comorbidity Indices in Predicting Overall Survival in Elderly Patients with Newly Diagnosed Multiple Myeloma. // Biomed Res Int. 2014. Vol. 2014. P. 437852.
16. Caughey G.E., Ramsay E.N., Vitry A.I., et al. Comorbid chronic diseases, discordant impact on mortality in older people: a 14-year longitudinal population study // J. Epidemiol Community Health. 2010. Vol. 64(12). P. 1036-1042.
17. Sorror M.L., Maris M.B., Storb R., et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. // Blood. 2005. Vol. 106. P. 2912–2919.
18. Charlson M.E., Pompei P., Ales K.L., MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. // J Chronic Dis. 1987. Vol. 40. P. 373-383.
19. Kaplan M.H., Feinstein A.R. The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. // J Chronic Dis. 1974. Vol. 27. P. 387–404.
20. Satariano W.A., Ragland D.R. The effect of comorbidity on 3-year survival of women with primary breast cancer. // Ann Intern Med. 1994. Vol. 120. P. 104–110.
21. Miller M., Towers A. A manual of guidelines for scoring the cumulative illness rating scale for geriatrics (CIRS-G). May 1991. Available from:http://www.anq.ch/fileadmin/redaktion/deutsch/20121211_CIRSG_Manual_E. pdf. (accessed 12.04.2016).
REFERENCES
1. Mendeleeva L.P., Votyakova O.M. O.S., et al. National clinical guidelines for the diagnosis and treatment of multiple myeloma. // Gematologiya i transfuziologiy = Hematology and Transfusiology. 2016. Vol. 61 (1, Suppl. 2). P. 1–24 (in Russisn). DOI: 10.18821/0234-5730-2016-61-1.
2. Kyle R.A., Rajkumar S.V. Epidemiology of the plasma-cell disorders. // Best Pract Res Clin Haematol. 2007. Vol. 20(4). P. 637–64. DOI:10.1016/j.beha.2007.08.001.
3. Waxman A.J., Mink P.J., Devesa S.S., et al. Racial disparities in incidence and outcome in multiple myeloma: apopulation-based study. // Blood. 2010. Vol. 116 (25). P. 5501–5506. DOI: 10.1182/ blood-2010-07-298760.
4. Crusoe Ede Q., da Silva A.M., Agareno J., et al. Multiple myeloma: a rare case in an 8-year-old child. // Clin Lymphoma Myeloma Leuk. 2015. Vol. 15(1). P. e31–e3. DOI: 10.1016/j. clml.2014.08.004.
5. Kristinsson S.Y., Landgren O., Dickman P.W., Derolf A.R., Björkholm M. Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. // J Clin Oncol. 2007. Vol. 25(15). P. 1993-1999.
6. Brenner H., Gondos A., Pulte D. Recent major improvements in long-term survival of younger patients with multiple myeloma. // Blood. 2008. Vol. 111(5). P. 2521-2526.
7. Schaapveld M., Visser O., Siesling S., et al. Improved survival among younger but not among older patients with multiple myeloma in the Netherlands, a population-based study since 1989. // Eur J Cancer. 2010. Vol. 46(1). P. 160-169.
8. Kumar S.K., Rajkumar S.V., Dispenzieri A., et al. Improved survival in multiple myeloma and the impact of novel therapies. // Blood. 2008. Vol. 111(5). P. 2516-2520.
9. Altekruse S.F., Kosary C.L., Krapcho M., et al., editors. SEER Cancer Statistics Review. Bethesda, MD: National Cancer Institute; 1975-2007. http://seer.cancer.gov/csr/1975_2007/, based on November 2009 SEER data submission, posted to the SEER Web site 2010.
10. Kristinsson S.Y., Landgren O., Dickman P.W., et al. Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. // J Clin Oncol. 2007. Vol. 25(15). P. 1993-1999.
11. Brenner H., Gondos A., Pulte D. Recent major improvements in long-term survival of younger patients with multiple myeloma. // Blood. 2008. Vol. 111(5). P. 2521-2526.
12. Hallek M., Fischer K., Fingerle-Rowson G., et al. Addition of rituximab to fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a randomised, open-label, phase 3 trial. // The Lancet. 2010. Vol. 376(9747). P. 1164–74. DOI: 10.1016/S0140-6736(10)61381-5.
13. Yancik R. Cancer burden in the aged: an epidemiologic and demographic overview. // Cancer. 1997. Vol. 80(7). P. 1273–83. DOI: 10.1002/(sici)10970142(19971001)80:7<1273::aid-cncr13>3.0.co;2-4.
14. Kleber M., Ihorst G., Terhorst M., et al. Comorbidity as a prognostic variable in multiple myeloma: comparative evaluation of common comorbidity scores and use of a novel MM–comorbidity score. // Blood Cancer J. 2011. Vol. 1(9). P. e35.
15. Sung Min Kim, Moon Jin Kim, Hyun Ae Jung, et al. Comparison of the Freiburg and Charlson Comorbidity Indices in Predicting Overall Survival in Elderly Patients with Newly Diagnosed Multiple Myeloma. // Biomed Res Int. 2014. Vol. 2014. P. 437852.
16. Caughey G.E., Ramsay E.N., Vitry A.I., et al. Comorbid chronic diseases, discordant impact on mortality in older people: a 14-year longitudinal population study // J. Epidemiol Community Health. 2010. Vol. 64(12). P. 1036-1042.
17. Sorror M.L., Maris M.B., Storb R., et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. // Blood. 2005. Vol. 106. P. 2912–2919.
18. Charlson M.E., Pompei P., Ales K.L., MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. // J Chronic Dis. 1987. Vol. 40. P. 373-383.
19. Kaplan M.H., Feinstein A.R. The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. // J Chronic Dis. 1974. Vol. 27. P. 387–404.
20. Satariano W.A., Ragland D.R. The effect of comorbidity on 3-year survival of women with primary breast cancer. // Ann Intern Med. 1994. Vol. 120. P. 104–110.
21. Miller M., Towers A. A manual of guidelines for scoring the cumulative illness rating scale for geriatrics (CIRS-G). May 1991. Available from:http://www.anq.ch/fileadmin/redaktion/deutsch/20121211_CIRSG_Manual_E. pdf. (accessed 12.04.2016).
2. Kyle R.A., Rajkumar S.V. Epidemiology of the plasma-cell disorders. // Best Pract Res Clin Haematol. 2007. Vol. 20(4). P. 637–64. DOI:10.1016/j.beha.2007.08.001.
3. Waxman A.J., Mink P.J., Devesa S.S., et al. Racial disparities in incidence and outcome in multiple myeloma: apopulation-based study. // Blood. 2010. Vol. 116 (25). P. 5501–5506. DOI: 10.1182/ blood-2010-07-298760.
4. Crusoe Ede Q., da Silva A.M., Agareno J., et al. Multiple myeloma: a rare case in an 8-year-old child. // Clin Lymphoma Myeloma Leuk. 2015. Vol. 15(1). P. e31–e3. DOI: 10.1016/j. clml.2014.08.004.
5. Kristinsson S.Y., Landgren O., Dickman P.W., Derolf A.R., Björkholm M. Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. // J Clin Oncol. 2007. Vol. 25(15). P. 1993-1999.
6. Brenner H., Gondos A., Pulte D. Recent major improvements in long-term survival of younger patients with multiple myeloma. // Blood. 2008. Vol. 111(5). P. 2521-2526.
7. Schaapveld M., Visser O., Siesling S., et al. Improved survival among younger but not among older patients with multiple myeloma in the Netherlands, a population-based study since 1989. // Eur J Cancer. 2010. Vol. 46(1). P. 160-169.
8. Kumar S.K., Rajkumar S.V., Dispenzieri A., et al. Improved survival in multiple myeloma and the impact of novel therapies. // Blood. 2008. Vol. 111(5). P. 2516-2520.
9. Altekruse S.F., Kosary C.L., Krapcho M., et al., editors. SEER Cancer Statistics Review. Bethesda, MD: National Cancer Institute; 1975-2007. http://seer.cancer.gov/csr/1975_2007/, based on November 2009 SEER data submission, posted to the SEER Web site 2010.
10. Kristinsson S.Y., Landgren O., Dickman P.W., et al. Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. // J Clin Oncol. 2007. Vol. 25(15). P. 1993-1999.
11. Brenner H., Gondos A., Pulte D. Recent major improvements in long-term survival of younger patients with multiple myeloma. // Blood. 2008. Vol. 111(5). P. 2521-2526.
12. Hallek M., Fischer K., Fingerle-Rowson G., et al. Addition of rituximab to fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a randomised, open-label, phase 3 trial. // The Lancet. 2010. Vol. 376(9747). P. 1164–74. DOI: 10.1016/S0140-6736(10)61381-5.
13. Yancik R. Cancer burden in the aged: an epidemiologic and demographic overview. // Cancer. 1997. Vol. 80(7). P. 1273–83. DOI: 10.1002/(sici)10970142(19971001)80:7<1273::aid-cncr13>3.0.co;2-4.
14. Kleber M., Ihorst G., Terhorst M., et al. Comorbidity as a prognostic variable in multiple myeloma: comparative evaluation of common comorbidity scores and use of a novel MM–comorbidity score. // Blood Cancer J. 2011. Vol. 1(9). P. e35.
15. Sung Min Kim, Moon Jin Kim, Hyun Ae Jung, et al. Comparison of the Freiburg and Charlson Comorbidity Indices in Predicting Overall Survival in Elderly Patients with Newly Diagnosed Multiple Myeloma. // Biomed Res Int. 2014. Vol. 2014. P. 437852.
16. Caughey G.E., Ramsay E.N., Vitry A.I., et al. Comorbid chronic diseases, discordant impact on mortality in older people: a 14-year longitudinal population study // J. Epidemiol Community Health. 2010. Vol. 64(12). P. 1036-1042.
17. Sorror M.L., Maris M.B., Storb R., et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. // Blood. 2005. Vol. 106. P. 2912–2919.
18. Charlson M.E., Pompei P., Ales K.L., MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. // J Chronic Dis. 1987. Vol. 40. P. 373-383.
19. Kaplan M.H., Feinstein A.R. The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. // J Chronic Dis. 1974. Vol. 27. P. 387–404.
20. Satariano W.A., Ragland D.R. The effect of comorbidity on 3-year survival of women with primary breast cancer. // Ann Intern Med. 1994. Vol. 120. P. 104–110.
21. Miller M., Towers A. A manual of guidelines for scoring the cumulative illness rating scale for geriatrics (CIRS-G). May 1991. Available from:http://www.anq.ch/fileadmin/redaktion/deutsch/20121211_CIRSG_Manual_E. pdf. (accessed 12.04.2016).
REFERENCES
1. Mendeleeva L.P., Votyakova O.M. O.S., et al. National clinical guidelines for the diagnosis and treatment of multiple myeloma. // Gematologiya i transfuziologiy = Hematology and Transfusiology. 2016. Vol. 61 (1, Suppl. 2). P. 1–24 (in Russisn). DOI: 10.18821/0234-5730-2016-61-1.
2. Kyle R.A., Rajkumar S.V. Epidemiology of the plasma-cell disorders. // Best Pract Res Clin Haematol. 2007. Vol. 20(4). P. 637–64. DOI:10.1016/j.beha.2007.08.001.
3. Waxman A.J., Mink P.J., Devesa S.S., et al. Racial disparities in incidence and outcome in multiple myeloma: apopulation-based study. // Blood. 2010. Vol. 116 (25). P. 5501–5506. DOI: 10.1182/ blood-2010-07-298760.
4. Crusoe Ede Q., da Silva A.M., Agareno J., et al. Multiple myeloma: a rare case in an 8-year-old child. // Clin Lymphoma Myeloma Leuk. 2015. Vol. 15(1). P. e31–e3. DOI: 10.1016/j. clml.2014.08.004.
5. Kristinsson S.Y., Landgren O., Dickman P.W., Derolf A.R., Björkholm M. Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. // J Clin Oncol. 2007. Vol. 25(15). P. 1993-1999.
6. Brenner H., Gondos A., Pulte D. Recent major improvements in long-term survival of younger patients with multiple myeloma. // Blood. 2008. Vol. 111(5). P. 2521-2526.
7. Schaapveld M., Visser O., Siesling S., et al. Improved survival among younger but not among older patients with multiple myeloma in the Netherlands, a population-based study since 1989. // Eur J Cancer. 2010. Vol. 46(1). P. 160-169.
8. Kumar S.K., Rajkumar S.V., Dispenzieri A., et al. Improved survival in multiple myeloma and the impact of novel therapies. // Blood. 2008. Vol. 111(5). P. 2516-2520.
9. Altekruse S.F., Kosary C.L., Krapcho M., et al., editors. SEER Cancer Statistics Review. Bethesda, MD: National Cancer Institute; 1975-2007. http://seer.cancer.gov/csr/1975_2007/, based on November 2009 SEER data submission, posted to the SEER Web site 2010.
10. Kristinsson S.Y., Landgren O., Dickman P.W., et al. Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. // J Clin Oncol. 2007. Vol. 25(15). P. 1993-1999.
11. Brenner H., Gondos A., Pulte D. Recent major improvements in long-term survival of younger patients with multiple myeloma. // Blood. 2008. Vol. 111(5). P. 2521-2526.
12. Hallek M., Fischer K., Fingerle-Rowson G., et al. Addition of rituximab to fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a randomised, open-label, phase 3 trial. // The Lancet. 2010. Vol. 376(9747). P. 1164–74. DOI: 10.1016/S0140-6736(10)61381-5.
13. Yancik R. Cancer burden in the aged: an epidemiologic and demographic overview. // Cancer. 1997. Vol. 80(7). P. 1273–83. DOI: 10.1002/(sici)10970142(19971001)80:7<1273::aid-cncr13>3.0.co;2-4.
14. Kleber M., Ihorst G., Terhorst M., et al. Comorbidity as a prognostic variable in multiple myeloma: comparative evaluation of common comorbidity scores and use of a novel MM–comorbidity score. // Blood Cancer J. 2011. Vol. 1(9). P. e35.
15. Sung Min Kim, Moon Jin Kim, Hyun Ae Jung, et al. Comparison of the Freiburg and Charlson Comorbidity Indices in Predicting Overall Survival in Elderly Patients with Newly Diagnosed Multiple Myeloma. // Biomed Res Int. 2014. Vol. 2014. P. 437852.
16. Caughey G.E., Ramsay E.N., Vitry A.I., et al. Comorbid chronic diseases, discordant impact on mortality in older people: a 14-year longitudinal population study // J. Epidemiol Community Health. 2010. Vol. 64(12). P. 1036-1042.
17. Sorror M.L., Maris M.B., Storb R., et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. // Blood. 2005. Vol. 106. P. 2912–2919.
18. Charlson M.E., Pompei P., Ales K.L., MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. // J Chronic Dis. 1987. Vol. 40. P. 373-383.
19. Kaplan M.H., Feinstein A.R. The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. // J Chronic Dis. 1974. Vol. 27. P. 387–404.
20. Satariano W.A., Ragland D.R. The effect of comorbidity on 3-year survival of women with primary breast cancer. // Ann Intern Med. 1994. Vol. 120. P. 104–110.
21. Miller M., Towers A. A manual of guidelines for scoring the cumulative illness rating scale for geriatrics (CIRS-G). May 1991. Available from:http://www.anq.ch/fileadmin/redaktion/deutsch/20121211_CIRSG_Manual_E. pdf. (accessed 12.04.2016).
Published
2019-01-20
How to Cite
СКВОРЦОВА, Наталия Валерьевна et al.
COMPARATIVE ANALYSIS OF COMORBIDITY INDICES WITH MULTIPLE MYELOMA.
Sibirskij Medicinskij Zurnal (Irkutsk) = Siberian Medical Journal (Irkutsk) 16+, [S.l.], v. 153, n. 2, p. 29-36, jan. 2019.
ISSN 1815-7572. Available at: <http://smj.ismu.baikal.ru/index.php/osn/article/view/290>. Date accessed: 01 jan. 2026.
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Original research
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