Retrospective Study Of Incidence Of Thromboses In Chinese Versus African Americans With Multiple Myeloma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1121-1121
Author(s):  
Radha Raghupathy ◽  
Sabarish Ayyappan ◽  
Dhivya Prabhakar ◽  
Frankie KF Mo ◽  
Erica L. Campagnaro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Retrospective Study ◽  
Lower Risk ◽  
Conflicts Of Interest ◽  
Significant Risk ◽  
Chinese Patients ◽  
Asian Patients ◽  
Venous Thromboembolic Events ◽  
The Difference

Abstract Background Risk of arterial (ATE) and venous thromboembolic events (VTE) is increased in multiple myeloma (MM). Immunomodulator therapy (Imid) concurrent with steroids further increases this risk. Retrospective single arm studies suggest that Asian patients with MM may have a lower risk of TE than in other ethnicities. We performed a retrospective study comparing Chinese (C) and African American (AA) patients in two centers, the Department of Clinical Oncology, Prince of Wales Hospital, the Chinese University of Hong Kong (PWH) and the University hospitals, Case Medical Center, Cleveland, Ohio (CMC), for ethnic differences in incidence of TE in MM. Methods 120 Chinese patients from PWH and 100 AA patients from CMC fulfilling IMWG consensus criteria for MM diagnosis between Jan 1st 2000 and Dec 31st 2011 were identified and selected for analysis. Data regarding demographics, comorbidities, myeloma characteristics, therapy and thrombotic complications were collected by electronic and paper chart review. Data collection was censored as of Dec 31st 2012. Results The Chinese cohort comprised more men, lower baseline incidence of diabetes (DM), hypertension (HTN) and non-myeloma related renal failure (CRF), advanced myeloma at diagnosis and more IgA subtype than AA. Over 90% of patients of both groups received chemotherapy. 72% of Chinese and 80% of AA received Imid based treatment. Lenalidomide with steroids was used more often in AA (36.8% AA vs 3.6%C, p<0.0001), Chinese received more thalidomide with steroids. (62.2% C vs 42.1%, p:0.004) Use of thromboprophylaxis (TP) is not routine in PWH, less Chinese were on TP during the disease course (11.7% vs 68%, p<0.0001) or during Imid based treatment. (16% vs 85%, p: 0.0001) Relative rates of aspirin, low molecular weight heparin and warfarin usage for TP were similar across both groups. Despite lower TP rates, a significantly lower rate of symptomatic VTE was observed in the Chinese. (3.3% vs 22%, p:0.001) The difference in VTE detection persisted on correction for number of imaging studies performed, 24 imaging tests in Chinese and 145 in AA. (16.7% vs 48.3%, p:0.004). Amongst the Chinese, all 4 events (100%) occurred on thalidomide dexamethasone (TD), 3 events (75%) in the absence of TP. In the AA, 21 of 26 events (81%) occurred on Imid based treatment. 12 events (46%) occurred in the absence of TP. On binary logistic regression using race, gender, prior venous thrombosis, any TP, TD and lenalidomide dexamethasone therapy as covariates, AA race (OR: 5.022, 95% CI:1.3- 19.4) and TD therapy (OR: 4.07, 1.26- 3.13) emerged as significant risk factors for VTE. Overall incidence of VTE on TD treatment was 4.5% in Chinese versus 22% in AA. (p:0.002) An increased number of arterial events were seen in the Chinese (9.2% vs 3% in AA) but the difference did not reach statistical significance. Of the 11 arterial events in Chinese, 5 (46%) occurred on Imid based therapy, 9 events (82%) were in the absence of TP. 7 were cardiac and 4 cerebrovascular. Of the 3 arterial events in AA, 1 (33.3%) occurred on Imids and all patients were receiving TP. 1 was cardiac, 1 abdominal and 1 upper limb. Conclusion Our study suggests that the Chinese have a lower risk of VTE than AA in the setting of MM. However , despite lower prevalence of most vascular risk factors in Chinese, ATE rates in Chinese were higher than AA, while not statistically significant. Larger studies are necessary to further elucidate these differences in thrombosis risk and to develop specific guidelines for TP in Asian patients with MM Disclosures: No relevant conflicts of interest to declare.

Polyclonal Gamma Globulin Suppression and Risk Of MGUS Progression Into Multiple Myeloma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1875-1875 ◽  
Author(s):  
Jawad Z. Sheqwara ◽  
Mohammad Alhyari ◽  
Shannon Keating ◽  
Philip Kuriakose
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Plasma Cell ◽  
Total Protein ◽  
Gamma Globulin ◽  
Conflicts Of Interest ◽  
Significant Risk ◽  
M Protein ◽  
Plasma Cell Dyscrasia ◽  
Female Ratio

Abstract Monoclonal gammopathy of undetermined significance (MGUS) is the most common form of plasma cell dyscrasia, with a prevalence of 3% in the general population above age of fifty. MGUS has a malignant evolution rate of 1% per year. Large longitudinal studies have suggested that virtually all patients diagnosed with multiple myeloma (MM) had a preceding MGUS, with 75 % having detectible Monoclonal (M) protein ≥8 years prior to diagnosis. It is important to identify the features at diagnosis that can predict neoplastic transformation to MM. Purpose We identified 239 patients at our institute in whom MGUS was diagnosed between 2000 and 2010. The presenting clinico-hematologic features were correlated with the frequency of evolution into MM to identify early predictors of evolution. The primary end point was progression to MM. Results The patients' mean age was 70.7 years. The Male/Female ratio was 0.7. The mean concentration of the M component (MC) was 0.7 g/dL. IgG was the most frequent MC (77%), followed by IgA (13%). The median ratio of MC protein to total protein was 0.5. Single or multiple background polyclonal (PC) suppression was noted in 36% of patients. PC suppression of 50% or more was noted in 20.1% of patients, 49.8% had < 50% and 30.1% had no suppression. Mean bone marrow plasma cell percentage was 4.5 percent and mean hemoglobin was 12.4 g/dL. Eighteen of the 239 patients with MGUS progressed into MM over ten years of follow up. Univariate comparisons of all variables between those who progressed and those who did not, showed that the initial concentration of the serum M protein, ratio of M protein to the total protein, number of PC gamma globulins suppressed, degree of PC suppression and IgM gamma globulin suppression were statistically significant risk factors that correlated with progression into MM. Fourteen out of eighteen patients with progressive disease had either PC suppression or background IgM suppression. Conclusions Monoclonal protein concentration, ratio of M protein to the total protein and abnormal serum free light chain ratio are simple variables that have been shown in multiple previous studies to predict the progression of MGUS into MM. In our study, we additionally found that number of PC suppressed, degree of suppression and IgM suppression are also key risk factors that can predict progression. We believe that these variables can be potentially applied into an approach that uses a detailed risk stratification system to predict which cases of MGUS will progress into MM and to provide more intensive monitoring for patients more likely to progress. Disclosures: No relevant conflicts of interest to declare.

Incidence of venous thromboembolic events (VTE) in multiple myeloma patients receiving lenalidomide (LEN) with and without dexamethasone (DEX).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e18559-e18559
Author(s):  
Nancy A. Brandenburg ◽  
Tyler Knight ◽  
Kathryn P. Anastassopoulos ◽  
Neil Minton ◽  
Robert D. Knight
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Dose Level ◽  
Cumulative Incidence ◽  
Cox Model ◽  
Significant Risk ◽  
High Dose ◽  
Pivotal Phase ◽  
Double Blind ◽  
Venous Thromboembolic Events

e18559 Background: LEN showed significant efficacy and was generally well tolerated when combined with DEX in two randomized, double-blind, pivotal phase 3 registration trials in relapsed or refractory multiple myeloma (MM). VTEs have been associated with LEN and DEX combination (LEN+DEX) regimens in patients (pts) who may have other risk factors for VTE. Fewer VTEs have been reported among pts receiving low dose DEX. This study examined the incidence of first VTE and associated risk factors among MM pts receiving LEN and LEN+DEX. Methods: An exploratory, retrospective, claims-based study of pts diagnosed with MM and receiving LEN from Jan 2006 – June 2008 was performed using OptumInsight’s Invision Data Mart Multiplan database. Pts receiving additional MM chemotherapies were excluded. DEX dose level was defined over the first four 28-day cycles of LEN as: low (≤160 mg), medium (>160 mg to <480 mg), or high (≥ 480 mg). Cumulative incidence of first VTE (deep vein thrombosis or pulmonary embolism) within 120 days of initiating LEN treatment was calculated from Kaplan-Meier curves. Risk factors for VTE were examined using hazard ratios (HRs) from a Cox model that included demographics, prior MM therapy, comorbid conditions, DEX dose, and prophylactic use of anti-thrombotics. Results: 643 LEN-treated MM pts were identified (mean age 60 years, 60% male, 13.5% with prior VTE). Cumulative incidence of first VTE at 120 days from first LEN dose was 6.1% overall (95% CI 4.4-8.3%) and 7.2% (5.1-10.2%) in LEN+DEX. VTE risk for LEN without DEX (n=190; 66 with other steroids) was 3.4% (1.5-7.5%). VTE risk by DEX dose level was 5.9% (3.6-9.7%) for low DEX (n=286), 7.5% (3.6-15.1%) for medium DEX (n=99), and 12.3% (6.3-23.1%) for high DEX (n=66). Significant risk factors for VTE were prior VTE (HR=3.9; p<0.001), recent surgery (HR=2.1; p=0.047), renal failure (HR=2.2; p=0.023), and high dose DEX (HR=2.3; p=0.045). Conclusions: Incommunity-based MM pts treated with LEN+DEX, VTE risk increases with the dose of DEX. The exact mechanism by which DEX intensity impacts VTE is not clear. In addition to high dose DEX, other known VTE risk factors were observed.

Osteonecrosis of the Jaw in Multiple Myeloma Patients: Incidence and Characteristics in Korean Patients.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4956-4956 ◽  
Author(s):  
Hyo Jung Kim ◽  
Hyeok Shim ◽  
Eunkyung Park ◽  
Min Kyoung Kim ◽  
Seok Jin Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Retrospective Study ◽  
Conflicts Of Interest ◽  
Previous History ◽  
Clinical Manifestations ◽  
Osteonecrosis Of The Jaw ◽  
Korean Patients ◽  
Dental Procedures ◽  
Exposed Bone

Abstract Abstract 4956 Introduction Osteonecrosis of the Jaw (ONJ) is a potentially serious complication of bisphosphonate (BP) therapy in multiple myeloma (MM). Despite of current update about bisphosphonate related ONJ (BRONJ), only a few Asian BRONJ cases were reported and incidence of BRONJ in Asian MM patients has not yet been definitively estimated. The purpose of this study was to determine incidence and characteristics of BRONJ in Korean MM patients who were receiving BP therapy. Patients and Methods We invited 9 hospitals of Korean Multiple Myeloma Working Group (KMMWP) to participate in a retrospective multicenter study on BRONJ in MM patients. To defined BRONJ incidence, we reviewed the data from 130 MM patients treated with BP in one hospital. We also reviewed the medical records of MM patients with BRONJ treated in 9 hospitals to know the patterns of disease. We analyzed patient and disease characteristics, type and number of BP infusions, previous history of dental procedures, locations of osteonecrosis, clinical symptoms, treatment and outcome. ONJ was defined as clinical evidence of exposed bone in the jaw, which has been present for more than 8 weeks. Results Nine of 130 MM patients (6.9%) treated with BP developed BRONJ in the hospital. Twenty-two patients with MM developed BRONJ after a median number of 17 BP infusions (range 6 - 50) in all 9 hospitals. None of the patients had been irradiated to the jaw. There were 14 male and 8 female patients. The median age was 62 years (range 46 – 75). Median time from MM diagnosis to BRONJ was 2.8 years (range 0.6 – 15.6). The MM isotype was IgG in 9, IgA in 8, IgM in 1, light chain in 3 and non-secretory myeloma in 1 patient. BP therapy included zoledronate (n = 2) or pamidronate (n = 4) and both drugs as sequential treatment (n = 16). Fifteen patients had recent problems in oral cavity (72.7%) and 14 had prior dental procedures (63.6%). The mandible was involved in 14 patients (63.6%), the maxilla in 7 (31.8%), and both the maxilla and mandible in 1 (4.5%). Patients usually presented with pain and soft tissue swelling. ONJ staging (Khan et al. Canadian consensus practice guidelines of Bisphosphonate associated ONJ. J Rheumatol 2008;35:1391-7) was used to define the severity, there were 5 patients in stage I, 14 in stage II and 1 in stage III. Because of the limitation of retrospective study, the stage of 2 patients could not be confirmed. Management of these established cases were discontinuation of BP and medical treatment including antibiotics and pain killer. Surgical debridement of necrotic bone was performed in 12 patients. From onset of exposed bone in jaw, patients were followed for median 11 months (range 4.2 - 42). Wounds of 10 patients were healed at median 175 days (range 60 – 404) after bone exposure. In 8 patients, lesions had persisted over 154 days (range 66 – 425). Evaluation was impossible for 4 patients due to loss of follow up. Four patients were dead because of disease progression (n = 3) or concomitant infection. BRONJ was healed in 2 of them. Conclusions To the best of our knowledge, this is the largest retrospective study ever reported about BRONJ in Asian MM patients. The incidence of BRONJ in Korean MM patients was 6.9% and this is similar with data in western countries. Clinical manifestations and outcome of BRONJ in Korean patients were not different from previously reported data, but no risk factors could be definitively identified with our retrospective analysis. In the name of KMMWP, prospective trials are ongoing to define incidence and risk factors of BRONJ in Korean MM patients. Disclosures No relevant conflicts of interest to declare.

Risk of Early Mortality in Patients with Newly Diagnosed Multiple Myeloma

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5306-5306
Author(s):  
Chia-Jen Liu ◽  
Pei Hsu ◽  
Ting-Wei Lin ◽  
Jyh-Pyng Gau ◽  
Liang-Tsai Hsiao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Serum Albumin ◽  
Serum Calcium ◽  
Conflicts Of Interest ◽  
Significant Risk ◽  
High Serum ◽  
Early Mortality ◽  
Newly Diagnosed ◽  
Low Serum

Abstract Background The overall survival of patients with multiple myeloma has been improved greatly over the last two decades with the advances of treatment. Several studies reported that this improvement in survival has been ascribed to the broader use of novel drugs and autologous tandem transplantation. However, there were still a certain portion of myeloma patients died early after diagnosis. We therefore aim to investigate the risk factors of early mortality (death within 60 days after diagnosis) in patients with multiple myeloma. Patients and Methods We included in this study 451 consecutive patients with multiple myeloma, newly diagnosed at an Asian tertiary medical center between January 1, 2002 and April 30, 2015. A total 57 subjects who developed early mortality were identified. Risk factors for early mortality in myeloma patients were collected and analyzed. Results Compared with non-early mortality myeloma patients, early mortality patients had higher probability of being male, primary plasma cell leukemia, low platelet count, low serum albumin, high corrected serum calcium, high serum creatinine, high LDH, high serum β2-microglobulin, poor performance status, and high ISS stage. With multivariate analysis, we found that male (adjusted OR 2.93, 95% CI 1.17-7.31), serum albumin < 3.5g/dl (adjusted OR 2.76, 95% CI 1.17-6.52), corrected serum calcium ≥ 12mg/dl (adjusted OR 3.56, 95% CI 1.47-8.63) and LDH ≥ 250U/L (adjusted OR 3.30, 95% CI 1.62-6.74) were significant risk factors of early mortality. Pneumonia represented as the leading cause of early mortality in myeloma patients (n = 18, 31.5%), followed by renal failure (n = 7, 12.2%). Conclusion Early mortality rate is high (12.6%) in patients with multiple myeloma. Patients of male gender, low serum albumin, high corrected serum calcium and LDH are at risk of early mortality. More than one third myeloma patients (21 out of 57) who developed early mortality are died of infection. Identifying the risk group and providing prompt intervention, such as prophylaxis antibiotics, may reduce the incidence rate of early mortality and improve the life expectancy of myeloma patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals Clinical Profile of Multiple Myeloma in Asia - an Asian Myeloma Network (AMN) Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 5035-5035
Author(s):  
Jae Hoon Lee ◽  
Kihyun Kim ◽  
Jin Seok Kim ◽  
Chang Ki Min ◽  
Sung-Soo Yoon ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Survival Data ◽  
Clinical Characteristics ◽  
Response Rate ◽  
Conflicts Of Interest ◽  
Asian Countries ◽  
Genetic Characteristics ◽  
Asian Patients ◽  
The Difference ◽  
Few Data

Abstract Abstract 5035 Background: The incidence of multiple myeloma (MM) is known to be variable according to ethnicity. However the difference of clinical characteristics between ethnic groups is not well-defined. In Asian countries the incidence of MM has been lower compared with Western countries. However, there are growing evidences that MM is increasing very rapidly in this region. Until now, only few data of Asian patients has been reported. Asian myeloma network (AMN) decided to analyze the first multinational project to explore clinical characteristics of Asian MM patients and clinical practice performed in Asian countries. Methods: Data were collected from 22 centers from 7 countries and regions were collected retrospectively. Clinical characteristics of 3377 symptomatic MM patients at diagnosis were described. Overall survival (OS) and prognostic factors were analyzed for 3324 patients who have survival data. Results: Clinical and genetic characteristics were summarized at table 1. Median OS was 47 months (95% CI 48. 0–60. 0). Patients who were diagnosed before 2000 were shorter survival. Transplantation was performed to 607 patients with better survival (84 vs 40 months, p<0. 001). First line treatment of 2906 evaluable patients was analyzed. Overall response rate was 71% including VGPR or better 31%. Novel drug-based regimens including bortezomib, thalidomide or lenalidomide were used for 32. 5% of all 2906 patients without difference in response rate or OS. Conclusions: We successfully described clinical characteristics of Asian MM patients and this project will be the base for future studies or clinical trials for Asian MM patients. Updated analyses and comparison with Western data will be presented. AMN, supported by the International Myeloma Foundation (IMF) IMWG initiative. Disclosures: No relevant conflicts of interest to declare.

Bleeding, thrombosis and transfusion in patients on ECMO: A retrospective study in a tertiary center in Hong Kong

2020 ◽  
pp. 039139882096558
Author(s):  
Ka Man Fong ◽  
Shek Yin Au ◽  
George Wing Yiu Ng ◽  
Anne Kit Hung Leung
Keyword(s):  
Risk Factors ◽  
Bloodstream Infection ◽  
Primary Outcome ◽  
Significant Risk ◽  
Tertiary Hospital ◽  
Chinese Patients ◽  
Bleeding Complications ◽  
Bleeding Events ◽  
Tertiary Center ◽  
Independent Risk Factors

Purpose: Use of anticoagulation in patients on ECMO, especially in Chinese, has always been difficult. This study aimed to review the incidence of bleeding, thrombosis, and transfusion requirement in Chinese ECMO patients and to identify risk factors for bleeding complications. Materials and Methods: This was a retrospective observational study of a tertiary hospital from 2010 to 2018. Patients aged ⩾18 years who received ECMO were included. The primary outcome was incidence of bleeding. Secondary outcomes included ICU mortality, hospital mortality, and length of the ICU and hospital stay. Results: Of the 130 patients, 55(42.3%) had at least one bleeding events and thrombosis occurred in 37(28.5%). A lower fibrinogen level (adjusted OR 0.56 (0.36–0.86), p = 0.009), bloodstream infection (adjusted OR 2.76 (1.01–7.53), p = 0.047) and longer duration on ECMO (adjusted OR 1.14 (1.02–1.27), p = 0.018) were independently associated with occurrence of bleeding. APTT (adjusted OR 0.99 (0.97–1.01), p = 0.370) and platelet count (adjusted OR 1.00 (0.98–1.01), p = 0.632) were not statistically significant risk factors for bleeding events. Conclusions: Bleeding and thrombosis were common complications in Chinese patients receiving ECMO. Hypofibrinogenemia and bloodstream infection, but not APTT nor platelet counts, were independent risk factors for bleeding events.

Significant Risk Factors of Reintubation After Passing the Spontaneous Breathing Trial: What Are We Missing? A 5-Year Retrospective Study

CHEST Journal ◽  
2017 ◽  
Vol 152 (4) ◽  
pp. A226
Author(s):  
Arthur Cacacho ◽  
Beata Popis-Matejak ◽  
Juan Cosico ◽  
Divya Nekkalapudi ◽  
Laura Andreias
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Spontaneous Breathing ◽  
Spontaneous Breathing Trial ◽  
Significant Risk

Prevalence and Risk Factors of Monoclonal Proteinemia in Thai Population.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1416-1416
Author(s):  
Phandee Watanaboonyongcharoen ◽  
Thanyaphong Na Nakorn ◽  
Ponlapat Rojnuckarin ◽  
Panisinee Lawasut ◽  
Tanin Intragumtornchai
Keyword(s):  
Risk Factors ◽  
Complete Blood Count ◽  
Conflicts Of Interest ◽  
Demographic Data ◽  
Significant Risk ◽  
Chemical Exposure ◽  
Blood Chemistry ◽  
Serum Samples ◽  
Thai Population ◽  
History Of

Abstract Abstract 1416 Poster Board I-439 Background: Monoclonal gammopathy of undetermined significance (MGUS) is associated with progression to multiple myeloma and related hematologic malignancies at the rate of 1% per year in western population. Reliable information on prevalence, risk factors and natural history of MGUS in general population are necessary for designing an early detection strategy for myeloma in Thailand. Patients and methods: The study was performed in subjects, 50 years of age or older, in Bangkok, one nearby province and 2 remote provinces of Thailand. The demographic data and suspected risk factor history were collected by questionnaires. Complete blood count as well as blood chemistry were done to exclude underlying hematologic and/or systemic conditions. Serum monoclonal proteins were detected using high-resolution gel electrophoresis. Results: Serum samples were obtained from 3,261 participants. There were 1,105 males (33.9%) and 2,156 females (66.1%). The median age was 57. Abnormal protein electrophoresis findings were detected in 76 samples (prevalence 2.3%, 95% confidence interval [CI] 1.8% - 2.8%) showing small M-spikes at gamma-globulin region in 50 (1.5%) or at beta-globulin region in 25 (0.8%) or hypogammaglobulinemia in 1 case (0.03%). The prevalence of MGUS in subjects less than 60, 60-69 and 70 yrs or more was 2.0% (41/1975), 2.6% (22/851) and 3.0% (13/435), respectively. Using multivariate analysis, presence of MGUS was strongly associated with history of drug abuse (odd ratio 4.63, 95%CI 1.14-22.08) and current residences outside Bangkok (odd ratio 2.30, 95%CI 1.18-4.79). Radiation and chemical exposure, hair and nail-coloring products and pesticides were not statistically significant risk factors in our population. Conclusions: The overall prevalence of MGUS in Thai population was 2.3%, lower than those of western countries but comparable to what reported from Japan and Taiwan. Disclosures: No relevant conflicts of interest to declare.

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