Program DHC-Virtual
20 - 21 January 2021
Clinical Abstracts session 3
Early mortality in multiple myeloma
20 January
12:06 12:18
M. Brink


Mirian Brink (1), Pieter Sonneveld (2), Monique C. Minnema (3), Annemiek Broyl (2), Avinash G. Dinmohamed (1,4,10), Ellen van der Spek (5), Mark-David Levin (6), Paula F. Ypma (7), Esther de Waal (8), Eduardus F.M. Posthuma (9), Sonja Zweegman (10), Niels W.C.J. van de Donk (10)
(1) Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research, Utrecht, (2) Erasmus MC Cancer Institute, Department of Hematology, Rotterdam, (3) UMC Utrecht, Department of Hematology, Utrecht, (4) Erasmus University Medical Center, Department of Public Health, Rotterdam, (5) Rijnstate Hospital, Department of Internal Medicine, Arnhem, (6) Albert Schweitzer Hospital, Department of Internal Medicine, Dordrecht, (7) Haga Teaching Hospital, Department of Hematology, The Hague, (8) Medical Center Leeuwarden, Department of Internal Medicine, Leeuwarden, (9) Reinier de Graaf Group, Department of Internal Medicine, Delft, (10) Cancer Center Amsterdam, Department of Hematology, Amsterdam
No potential conflicts of interest

The introduction of novel agents and autologous stem cell transplantation improved the population-level survival of patients with multiple myeloma (MM). However, early mortality (EM) remains a major clinical issue. Identification of risk factors of EM may contribute to more rigorous supportive care measures or different therapeutic approaches in patients at risk for EM. This population-based study aimed to assess trends in and risk factors of EM among MM patients diagnosed in the Netherlands during a 30-year period.


All MM patients diagnosed between 1989-2018with survival follow-up through 2020were identified from the Netherlands Cancer Registry. Primary end point was EM defined as the date from MM diagnosis to all-cause death ≤180 days. Patients were categorized into three calendar periods (1989-1998, 1999-2008, 2009-2018) and four age groups (≤65, 66-70, 71-80, >80 years). The impact of age, sex, period of diagnosis, hospital type at diagnosis and prior malignancies for EM was evaluated using uni- and multivariable Cox regression analyses. Moreover, for patients diagnosed in 2014-2018, detailed data on type of paraprotein, thrombocytopenia, serum albumin, serum β2-microglobulin, cytogenetic risk, calcium, renal failure, anemia and bone lesions at baseline was evaluated. P<0.05 indicates statistical significance.


Our analytical cohort included 28,328 MM patients (median age 70 years, age range 25-99; 55% males; 88% diagnosed in non-academic centers; 13% with prior malignancies). Median age and proportions of hospital type at diagnosis, and prior malignancies were similar across the three calendar periods. In 2009-2018, a higher proportion of male patients was observed as compared to 1989-1998 (57% vs. 52%; P<0.001).

EM for patients ≤65 was 11%, 11%, and 6% (P<0.001) in 1989-1998, 1999-2008, and 2009-2018, respectively. The corresponding proportions for patients aged 66-70 were 19%, 16%, and 8% (P<0.001), for patients 71-80, 25%, 22%, and 15% (P<0.001), and for patients >80, 40%, 41%, and 31% (P<0.001). When simultaneously adjusted for calendar period, sex, age, hospital type at diagnosis and prior malignancies, patients diagnosed in 2009-2018 had a 42% lower risk of mortality as compared with patients diagnosed in 1989-1998 (hazard ratio, 0.58; P<0.001) with an adverse effect of older age and prior malignancies. 

In 2014-2018, 6.380 MM patients were diagnosed of whom 780 (12%) patients died ≤180 days post-diagnosis. Albumin <35 g/L, β2-microglobulin ≥3.5 mg/L, thrombocytopenia, hypercalcemia, and poor renal function have an adverse effect on EM for patients 70. In addition, anemia and bone lesions 1 have an adverse effect on EM for patients >70.


In summary, EM among MM patients improved from 1999 onwards. Nevertheless, EM remains high, especially for patients aged >70 years. Patients at risk for EM may benefit from better supportive care or individualized anti-MM therapy.