Early mortality in multiple myeloma: Experiences from a single institution

Figures & data

Table 1 Clinical characteristics of the study cohort and comparisons between patients with and without early mortality

	Total patients (n = 122)	Survival ≤180 days (n = 28)	Survival >180 days (n = 94)	P
Age (years)	66.02 ± 1.07	64.36 ± 2.70	66.52 ± 1.14	0.722*
Sex (n, %)
Female	54 (44.26)	9 (32.14)	45 (47.87)	0.210^†
Male	68 (55.74)	19 (67.86)	49 (52.13)
ISS (n, %)
I	17 (13.93)	2 (7.14)	15 (15.96)	0.477^†
II	50 (40.98)	13 (46.43)	37 (39.36)
III	55 (45.09)	13 (46.43)	42 (44.68)
DSS (n, %)
I	42 (34.43)	10 (35.71)	32 (34.04)	0.118^†
II	32 (26.23)	11 (39.29)	21 (22.34)
III	48 (39.34)	7 (25.00)	41 (43.62)
First-line therapy (n, %)
Bortezomib-based	52 (42.26)	11 (39.29)	41 (43.62)	0.001^†
Non-bortezomib-based	66 (54.10)	13 (46.43)	53 (56.38)
No treatment	4 (3.64)	4 (14.28)	0 (0.00)
Creatinine ≥2.0 mg/dl (%)
No	79 (64.75)	14 (50.00)	65 (69.15)	0.102^†
Yes	43 (35.25)	14 (50.00)	29 (30.85)
Disease subtype (%)
IgG	52 (42.62)	15 (53.57)	37 (39.36)	0.369^†
IgA	28 (22.95)	7 (25.00)	21 (22.34)
Light chain disease	19 (15.57)	2 (7.14)	17 (18.09)
Others	23 (18.86)	4 (14.29)	19 (20.21)
Lactate dehydrogenase (140–240 IU/l)	240.04 ± 16.59	377.48 ± 57.43	200.56 ± 10.83	<0.001*
Albumin (3.5–5.0 g/dl)	3.21 ± 0.07	2.69 ± 0.13	3.37 ± 0.07	<0.001*
Total protein (6.0–8.0 g/dl)	9.34 ± 0.25	10.41 ± 0.61	9.02 ± 0.27	0.029*
β2-Microglobulin (660–2740 ng/dl)	8769.13 ± 755.70	13 269.32 ± 2617.95	7730.62 ± 671.93	0.083*
Calcium (8.4–10.2 mg/dl)	8.10 ± 0.16	7.94 ± 0.34	8.14 ± 0.18	0.414*
Creatinine (0.7–1.4 mg/dl)	3.23 ± 0.72	3.56 ± 0.63	3.13 ± 0.91	0.027*
Hemoglobin (12.0–17.5 g/dl)	9.91 ± 0.22	10.41 ± 0.52	9.76 ± 0.25	0.192*

Data were compared between patients with and without early mortality and are presented as the mean ± standard error of mean or as number (percentage).

ISS, international staging system; DSS, Durie–Salmon staging system; IgG, immunoglobulin G; IgA, immunoglobulin A.

*Data were compared using analysis of variance.

^†Data were compared using the chi-square test.

Table 2 Causes of early mortality in MM patients

Pt No.	Age (years)	Sex	Cause of death (infection type, if available)	Pathogen (culture specimen)	Survival time (days)	ISS	DSS
1	86	M	Infection (pneumonia)	Escherichia coli (B/C)	0	III	IB
2	51	M	Infection (pneumonia)	Klebsiella pneumoniae (B/C)	0	III	IIIB
3	63	F	Pulmonary embolism		0	II	IIIB
4	77	F	Acute renal failure		3	III	IIB
5	73	F	Infection (septic shock)	E. coli (B/C)	5	III	IIA
6	48	M	Cardiac arrest		8	II	IA
7	79	M	Infection (septic shock)	Enterococcus faecium (B/C)	9	III	IIIB
8	45	M	Infection (pneumonia)	OSSA (S/C)	10	II	IB
9	68	M	Infection (pneumonia)	CRAB (S/C)	11	III	IIB
10	77	M	Infection (pneumonia)	Viridans streptococci (throat swab)	17	II	IIIB
11	72	M	Intracranial hemorrhage		17	III	IIB
12	75	M	Infection (pneumonia)	Pseudomonas aeruginosa (B/C)	21	III	IIB
13	56	M	Cardiac arrest		22	III	IIIA
14	64	F	Infection (peritonitis)	K. pneumoniae (B/C)	23	II	IA
15	70	F	Acute renal failure		27	II	IIA
16	47	M	Infection (pneumonia)	MRSA (B/C)	36	II	IIB
17	64	M	Infection (pneumonia)	Not identified	47	II	IIIB
18	66	F	Infection (pneumonia)	Enterobacter cloacae (B/C)	47	II	IA
19	47	M	Infection (pneumonia)	Not identified	48	II	IA
20	82	M	Infection (pneumonia)	K. pneumoniae (B/C)	96	III	IIIB
21	62	M	Infection (septic shock)	OSSA (B/C)	108	III	IIB
22	23	M	Infection (pneumonia)	Not identified	116	I	IA
23	75	M	Infection (urosepsis)	P. aeruginosa (U/C)	132	III	IIA
24	53	F	Unknown		138	I	IA
25	80	F	Hepatic failure		144	II	IIA
26	77	M	Infection (pneumonia)	E. coli (S/C)	147	III	IIA
27	64	F	Infection (pneumonia)	Not identified	157	II	IA
28	58	M	Unknown		167	II	IA

M, male; F, female; ISS, international staging system; DSS, Durie–Salmon staging system; B/C, blood culture; OSSA, oxacillin-resistant Staphylococcus aureus; S/C, sputum culture; CRAB, carbapenem-resistant Acinetobacter baumannii; MRSA, methicillin-resistant S. aureus.

Table 3 HR for early mortality in 122 MM patients

		Crude HR	95% CI	P	Adjusted HR	95% CI			P
β2-Microglobulin		1.000	1.000	1.000	0.001	1.000	1.000	1.000	<0.001
Albumin		0.296	0.173	0.506	<0.001	0.239	0.118	0.487	<0.001
Total protein		1.217	1.049	1.412	0.010	1.113	0.930	1.332	0.243
Lactate dehydrogenase		1.003	1.002	1.004	<0.001	1.005	1.003	1.006	<0.001
Age		0.987	0.957	1.019	0.419
Sex	Male vs. Female	1.795	0.812	3.969	0.148
Disease stage
ISS	II vs. I	2.446	0.552	10.843	0.239
	III vs. I	2.281	0.515	10.111	0.278
DSS	II vs. I	1.560	0.662	3.674	0.309
	III vs. I	0.609	0.232	1.599	0.314
Calcium		0.921	0.750	1.131	0.432
Creatinine		1.006	0.970	1.043	0.765
Hemoglobin		1.095	0.943	1.272	0.232

HR, hazard ratio; CI, confidence interval; ISS, international staging system; DSS, Durie–Salmon staging system.

Table 4 Clinical characteristics of MM patients with mortality between 31 and 180 days following diagnosis

	Non-bortezomib treatment (n = 25)	First-line bortezomib treatment (n = 48)	Greater than or equal to second-line bortezomib treatment (n = 34)	P
Age (years)	67.92 ± 12.04	63.94 ± 12.10	67.18 ± 11.22	0.298*
Sex (%)
Male	16 (64.00%)	22 (45.83%)	20 (58.82%)	0.271^†
Female	9 (36.00%)	26 (54.17%)	14 (41.18%)
β2-Microglobulin (660–2740 ng/dl)	7089.26 ± 6357.09	7814.02 ± 5539.77	8057.91 ± 7982.24	0.875*
Albumin (3.5–5.0 g/dl)	3.23 ± 0.79	3.38 ± 0.65	3.36 ± 0.64	0.658*
Total protein (6.0–8.0 g/dl)	9.34 ± 1.93	9.11 ± 2.67	9.09 ± 2.68	0.920*
Lactate dehydrogenase (140–240 IU/l)	228.68 ± 132.89	221.55 ± 108.10	180.06 ± 114.44	0.191*
Calcium (8.4–10.2 mg/dl)	8.44 ± 1.28	8.08 ± 2.00	8.31 ± 1.39	0.648*
Creatinine (0.7–1.4 mg/dl)	2.61 ± 3.02	4.15 ± 12.20	1.95 ± 1.87	0.481*
Hemoglobin (12.0–17.5 g/dl)	9.92 ± 2.24	9.95 ± 2.54	9.71 ± 2.32	0.900*
Follow-up time (days)	858.32 ± 687.30	694.29 ± 379.66	1080.12 ± 602.02	0.008*
Disease subtype
IgG	10 (40.00%)	19 (39.58%)	13 (38.24%)	0.011^†
IgA	4 (16.00%)	10 (20.84%)	10 (29.41%)
Light chain disease	0 (0.00%)	13 (27.08)	5 (14.71%)
Others	11 (44.00%)	6 (12.50%)	6 (17.64%)
ISS
I	3 (12.00%)	9 (18.75%)	5 (14.71%)	0.078^†
II	16 (64.00%)	14 (29.17%)	14 (41.18%)
III	6 (24.00%)	25 (52.08%)	15 (44.11%)
DSS
I	8 (32.00%)	19 (39.58%)	11 (32.35%)	0.930^†
II	7 (28.00%)	10 (20.84%)	9 (26.47%)
III	10 (40.00%)	19 (39.58%)	14 (41.18%)

Data are presented as mean ± standard error of mean or as number (percentage).

IgG, immunoglobulin G; IgA, immunoglobulin A; ISS, international staging system; ISS, international staging system; DSS, Durie–Salmon staging system.

*Data were compared using analysis of variance.

^†Data were compared using the chi-square test.

Table 5 HRs for overall survival in MM patients classified according to different treatment regimens

		HR	95% CI		P
180-day overall survival	First-line bortezomib	0.70	0.22	2.21	0.546
	Greater than or equal to second-line bortezomib	0.13	0.02	1.15	0.066
One-year overall survival	First-line bortezomib	0.79	0.33	1.91	0.599
	Greater than or equal to second-line bortezomib	0.31	0.09	1.04	0.058
Two-year overall survival	First-line bortezomib	0.89	0.45	1.74	0.731
	Greater than or equal to second-line bortezomib	0.48	0.21	1.07	0.074

HR, hazard ratio; CI, confidence interval.

No bortezomib was defined as the comparison treatment (reference value).