Skip to main content
SpringerLink
Log in

Survival differences in multiple myeloma in Latin America and Asia: a comparison involving 3664 patients from regional registries

  • Original Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

In previous observational studies, we have separately characterized patients with multiple myeloma (MM) both from Latin America (LA) and from Asia. Here, we analyze these two datasets jointly, in order to assess the overall survival (OS) in these two world regions. Data were available from 3664 patients (1968 from LA and 1696 from Asia); all of whom diagnosed between 1998 and 2007. Approximately, 26% of patients in both world regions underwent transplantation. OS (from diagnosis of MM) was explored with Kaplan–Meier analyses and Cox proportional hazards models. Patients from LA were significantly younger and had hypercalcemia more often than Asian patients, who in turn had higher proportions of anemia and International Staging System (ISS) stage III disease. The median OS was 56 months in LA, and 47 months in Asia (hazard ratio [HR] = 0.83; 95% confidence interval [CI], 0.76 to 0.91; P < 0.001). In multivariable analysis, age, ISS stage III, anemia, hypercalcemia, and world region remained significantly associated with OS (P < 0.001 for all covariates). These results were largely driven by patients not undergoing transplantation, as no difference in OS emerged between the two world regions in univariable or multivariable analysis for transplanted patients. Despite adverse prognostic features differentially favoring each region, and adjusting for such differences, we found an OS advantage for patients from LA, in comparison with contemporaneous patients from Asia. Whether this is due to different biological features, differences in access to novel agents (especially thalidomide in earlier periods of the study), unmeasured confounders, or the play of chance, remain unknown.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kumar SK, Rajkumar SV, Dispenzieri A, Lacy MQ, Hayman SR, Buadi FK, Zeldenrust SR, Dingli D, Russell SJ, Lust JA, Greipp PR, Kyle RA, Gertz MA (2008) Improved survival in multiple myeloma and the impact of novel therapies. Blood 111:2516–2520

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Moreau P, Attal M, Facon T (2015) Frontline therapy of multiple myeloma. Blood 125:3076–3084

    Article  CAS  PubMed  Google Scholar 

  3. Palumbo A, Anderson K (2011) Multiple myeloma. N Engl J Med 364:1046–1060

    Article  CAS  PubMed  Google Scholar 

  4. Myeloma Trialists’ Collaborative Group (1998) Combination chemotherapy versus melphalan plus prednisone as treatment for multiple myeloma: an overview of 6,633 patients from 27 randomized trials. Myeloma Trialists' Collaborative Group. J Clin Oncol 16:3832–3842

  5. Benboubker L, Dimopoulos MA, Dispenzieri A, Catalano J, Belch AR, Cavo M, Pinto A, Weisel K, Ludwig H, Bahlis N, Banos A, Tiab M, Delforge M, Cavenagh J, Geraldes C, Lee JJ, Chen C, Oriol A, de la Rubia J, Qiu L, White DJ, Binder D, Anderson K, Fermand JP, Moreau P, Attal M, Knight R, Chen G, van Oostendorp J, Jacques C, Ervin-Haynes A, Avet-Loiseau H, Hulin C, Facon T, FIRST Trial Team (2014) Lenalidomide and dexamethasone in transplant-ineligible patients with myeloma. N Engl J Med 371:906–917

    Article  CAS  PubMed  Google Scholar 

  6. Palumbo A, Hajek R, Delforge M, Kropff M, Petrucci MT, Catalano J, Gisslinger H, Wiktor-Jędrzejczak W, Zodelava M, Weisel K, Cascavilla N, Iosava G, Cavo M, Kloczko J, Bladé J, Beksac M, Spicka I, Plesner T, Radke J, Langer C, Ben Yehuda D, Corso A, Herbein L, Yu Z, Mei J, Jacques C, Dimopoulos MA, MM-015 Investigators (2012) Continuous lenalidomide treatment for newly diagnosed multiple myeloma. N Engl J Med 366:1759–1769

    Article  CAS  PubMed  Google Scholar 

  7. Attal M, Lauwers-Cances V, Marit G, Caillot D, Moreau P, Facon T, Stoppa AM, Hulin C, Benboubker L, Garderet L, Decaux O, Leyvraz S, Vekemans MC, Voillat L, Michallet M, Pegourie B, Dumontet C, Roussel M, Leleu X, Mathiot C, Payen C, Avet-Loiseau H, Harousseau JL, IFM Investigators (2012) Lenalidomide maintenance after stem-cell transplantation for multiple myeloma. N Engl J Med 366:1782–1791

    Article  CAS  PubMed  Google Scholar 

  8. Palumbo A, Cavallo F, Gay F, di Raimondo F, Ben Yehuda D, Petrucci MT, Pezzatti S, Caravita T, Cerrato C, Ribakovsky E, Genuardi M, Cafro A, Marcatti M, Catalano L, Offidani M, Carella AM, Zamagni E, Patriarca F, Musto P, Evangelista A, Ciccone G, Omedé P, Crippa C, Corradini P, Nagler A, Boccadoro M, Cavo M (2014) Autologous transplantation and maintenance therapy in multiple myeloma. N Engl J Med 371:895–905

    Article  CAS  PubMed  Google Scholar 

  9. Hungria VT, Crusoé EQ, Maiolino A, et al (2016) Phase 3 trial of three thalidomide-containing regimens in patients with newly diagnosed multiple myeloma not transplant-eligible. Ann Hematol 95:271–278

  10. Agência Nacional de Saúde Suplementar. Dados e Indicadores do Setor. Beneficiários de planos privados de saúde. Available at http://www.ans.gov.br/perfil-do-setor/dados-e-indicadores-do-setor. Accessed 27 May 2018

  11. Tan D, Chng WJ, Chou T, Nawarawong W, Hwang SY, Chim CS, Chen W, Durie BGM, Lee JH (2013) Management of multiple myeloma in Asia: resource-stratified guidelines. Lancet Oncol 14:e571–e581

    Article  PubMed  Google Scholar 

  12. Tarin-Arzaga L, Arredondo-Campos D, Martinez-Pacheco V et al (2018) Impact of the affordability of novel agents in patients with multiple myeloma: real-world data of current clinical practice in Mexico. Cancer 124:1946–1953

    Article  PubMed  Google Scholar 

  13. De Angelis R, Minicozzi P, Sant M et al (2015) Survival variations by country and age for lymphoid and myeloid malignancies in Europe 2000-2007: results of EUROCARE-5 population-based study. Eur J Cancer 51:2254–2268

    Article  PubMed  Google Scholar 

  14. Hungria VT, Maiolino A, Martinez G et al (2008) Confirmation of the utility of the International Staging System and identification of a unique pattern of disease in Brazilian patients with multiple myeloma. Haematologica 93:791–792

    Article  PubMed  Google Scholar 

  15. Hungria VT, Maiolino A, Martinez G et al (2017) Observational study of multiple myeloma in Latin America. Ann Hematol 96:65–72

    Article  CAS  PubMed  Google Scholar 

  16. Kim K, Lee JH, Kim JS, Min CK, Yoon SS, Shimizu K, Chou T, Kosugi H, Suzuki K, Chen W, Hou J, Lu J, Huang XJ, Huang SY, Chng WJ, Tan D, Teoh G, Chim CS, Nawarawong W, Siritanaratkul N, Durie BG (2014) Clinical profiles of multiple myeloma in Asia-an Asian myeloma network study. Am J Hematol 89:751–756

    Article  CAS  PubMed  Google Scholar 

  17. Greipp PR, San Miguel J, Durie BG et al (2005) International staging system for multiple myeloma. J Clin Oncol 23:3412–3420

    Article  PubMed  Google Scholar 

  18. Schemper M, Smith TL (1996) A note on quantifying follow-up in studies of failure time. Control Clin Trials 17:343–346

    Article  CAS  PubMed  Google Scholar 

  19. Richardson PG, San Miguel JF, Moreau P, Hajek R, Dimopoulos MA, Laubach JP, Palumbo A, Luptakova K, Romanus D, Skacel T, Kumar SK, Anderson KC (2018) Interpreting clinical trial data in multiple myeloma: translating findings to the real-world setting. Blood Cancer J 8:109

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lee W, Nelson R, Mailey B, Duldulao MP, Garcia-Aguilar J, Kim J (2012) Socioeconomic factors impact colon cancer outcomes in diverse patient populations. J Gastrointest Surg 16:692–704

    Article  PubMed  Google Scholar 

  21. Zell JA, Rhee JM, Ziogas A, Lipkin SM, Anton-Culver H (2007) Race, socioeconomic status, treatment, and survival time among pancreatic cancer cases in California. Cancer Epidemiol Biomark Prev 16:546–552

    Article  Google Scholar 

  22. Wang M, Burau KD, Fang S, Wang H, Du XL (2008) Ethnic variations in diagnosis, treatment, socioeconomic status, and survival in a large population-based cohort of elderly patients with non-Hodgkin lymphoma. Cancer 113:3231–3241

    Article  PubMed  Google Scholar 

  23. Fiala MA, Finney JD, Liu J, Stockerl-Goldstein KE, Tomasson MH, Vij R, Wildes TM (2015) Socioeconomic status is independently associated with overall survival in patients with multiple myeloma. Leuk Lymphoma 56:2643–2649

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hong S, Rybicki L, Abounader D, Bolwell BJ, Dean R, Gerds AT, Hamilton BK, Hill BT, Jagadeesh D, Kalaycio M, Liu HD, Pohlman B, Sobecks R, Majhail NS (2016) Association of socioeconomic status with outcomes of autologous hematopoietic cell transplantation for multiple myeloma. Biol Blood Marrow Transplant 22:1141–1144

    Article  PubMed  Google Scholar 

  25. Kumar SK, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Pandey S, Kapoor P, Dingli D, Hayman SR, Leung N, Lust J, McCurdy A, Russell SJ, Zeldenrust SR, Kyle RA, Rajkumar SV (2014) Continued improvement in survival in multiple myeloma: changes in early mortality and outcomes in older patients. Leukemia 28:1122–1128

    Article  CAS  PubMed  Google Scholar 

  26. US Department of Health and Human Services. National Institutes of Health. National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Myeloma. Available at https://seer.cancer.gov/statfacts/html/mulmy.html (Accessed 28 December 2018)

Download references

Author information

Authors and Affiliations

  1. Santa Casa Medical School, Rua Tucumã, 113 – 4° andar, Sao Paulo, 01455-010, Brazil

    Vania T. M. Hungria

  2. Hematology-Oncology, Division of Hematology/Oncology, Gachon University Gil Medical Center, Incheon, Republic of South Korea

    Jae Hoon Lee

  3. Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    Angelo Maiolino

  4. Hospital General Roberto Santos, Salvador, Brazil

    Edvan de Queiroz Crusoe

  5. Universidade de São Paulo, Sao Paulo, Brazil

    Gracia Martinez

  6. Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil

    Rosane Bittencourt

  7. Centro de Hematologia e Hemoterapia, Universidade de Campinas, Sao Paulo, Brazil

    Gislaine Oliveira Duarte

  8. Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Dorotea Beatriz Fantl

  9. Hospital Edgardo Rebagliati, Lima, Peru

    Juan Ramon Navarro

  10. Universidad de Chile, Santiago, Chile

    Guillermo Conte

  11. Servicio de Hematología, Universidad Autonoma de Nuevo Leon, Hospital Universitario “Dr. José Eleuterio Gonzalez”, Monterrey, Mexico

    David Gomez-Almaguer

  12. Clinica Ruiz De Puebla, Centro de Hematologia, Puebla, Mexico

    Guillermo J. Ruiz-Argüelles

  13. Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Kihyun Kim

  14. National Organization Higashi Nagoya National Hospital, Nagoya, Japan

    Kazuyuki Shimizu

  15. Beijing Chaoyang Hospital, Beijing, China

    Wenming Chen

  16. National Taiwan University Hospital, Taipei, Taiwan

    Shang-YI Huang

  17. National University Cancer Institute, Singapore, Singapore

    Wee-Joo Chng

  18. Queen Mary Hospital, University of Hong Kong, China, Pok Fu Lam, Hong Kong

    Chor Sang Chim

  19. Chiang Mai University, Maung, Chiang Mai, Thailand

    Weerasak Nawarawong

  20. Cedars-Sinai Medical Center, Los Angeles, USA

    Brian Durie

Authors
  1. Vania T. M. Hungria
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jae Hoon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Angelo Maiolino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edvan de Queiroz Crusoe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gracia Martinez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rosane Bittencourt
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gislaine Oliveira Duarte
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dorotea Beatriz Fantl
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Juan Ramon Navarro
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Guillermo Conte
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. David Gomez-Almaguer
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Guillermo J. Ruiz-Argüelles
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Kihyun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Kazuyuki Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Wenming Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Shang-YI Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Wee-Joo Chng
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Chor Sang Chim
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Weerasak Nawarawong
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Brian Durie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vania T. M. Hungria.

Ethics declarations

The protocol for each study was approved by the competent local authorities and institutional review boards, and written informed consent was obtained from all patients.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 52 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hungria, V.T.M., Lee, J.H., Maiolino, A. et al. Survival differences in multiple myeloma in Latin America and Asia: a comparison involving 3664 patients from regional registries. Ann Hematol 98, 941–949 (2019). https://doi.org/10.1007/s00277-019-03602-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-019-03602-4

Keywords

Search

Navigation