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Confirmation of the utility of the International Staging System and identification of a unique pattern of disease in Brazilian patients with multiple myeloma

2008; Ferrata Storti Foundation; Volume: 93; Issue: 5 Linguagem: Inglês

10.3324/haematol.11637

1592-8721

Vânia Hungria, Ângelo Maiolino, Gracia Martínez, Gisele W. B. Colleoni, Érika Coelho, Letícia Alves Rocha, Ricardo Bruno Félix Nunes, Rosane Bittencourt, Luciana Correa Oliveira de Oliveira, Rosa Malena O. Faria, Ricardo Pasqüini, S.M.M. Magalhães, Cármino Antônio De Souza, Jorge Vaz Pinto Neto, Leandro Barreto, Eli Iôla Gurgel Andrade, Maria do Socorro Oliveira Portella, Vanessa Bolejack, B. Durie,

Myeloproliferative Neoplasms: Diagnosis and Treatment

Confirmation of the utility of the International Staging System and identification of a unique pattern of disease in Brazilian patients with multiple myelomaMultiple myeloma (MM) is one of the most frequent hematologic malignancies, and its incidence varies worldwide.Except for occasional case series or correlative biological studies, little is known about the incidence and clinical features of MM in Latin America.In Brazil, national estimates for the incidence of MM are currently unavailable.Sixteen Brazilian institutions provided information on patients diagnosed with MM between 1998 and 2004.The investigators included all patients whose charts were available.All patients were undergoing care at these institutions.The diagnosis was based on the new criteria, 1 and/or standard clinical, laboratory and radiographical features, as well as on bone marrow findings compatible with MM.Since the majority of patients had Durie-Salmon stage (DSS) III, the diagnosis was not in doubt.Patients' data were obtained from institutional charts, and were entered on a web-based system specifically designed for the study under the auspices of the International Myeloma Foundation.We collected information regarding the demographical features of the patient, date of diagnosis, stage according to the DSS 2 and ISS, 3 type of monoclonal component, results of pertinent laboratory tests, type of treatment administered, and date of last follow-up or death.From 1998 to 2004, the patients who were not candidates for highdose chemotherapy (i.e., those who presented with poor performance status or for whom high-dose chemotherapy was not available) were treated with melphalan and prednisone.The database was analyzed in August 2006.A total number of 1,112 patients were included.χ 2 tests were used for the comparisons between proportions.Survival, defined from the date of diagnosis until death, was analyzed by the Kaplan-Meier method 4 and survival curves were compared using the log-rank test. 5Patients who were alive on the last visit or who were lost to follow-up were censored for survival analyses.Significant baseline univariate predictors of survival in the Kaplan-Meier analyses were considered for inclusion in a Cox regression model. 6ackward selection of all factors was used, and a variable was retained in the model if the associated twosided p value was ≤0.05.All statistical tests were twosided, and final p values ≤0.05 were considered significant.Main demographical and clinical features of the patients are shown in Table 1.The median follow-up was 20.5 months, and the estimated median overall survival was 57.7 months.At the time of the analysis, 392 patients (35.3%) were already deceased.Overall survival was analyzed according to DSS and ISS (Figure 1, Panels A and B).There was a statistically significant difference between the overall survival of patients with MM in stages I, II and III according to both staging systems (p<0.001).With DSS, however, there was a considerable overlap between the survival curves for patients in stage I and II (Figure 1, Panel A).The median overall survival for patients in DSS I and II had not been reached at the time of the analysis; for patients in stage III, the median overall