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Cheng CN, Huang SY, Lien PW, Huang ST, Lin FJ. Survival, health care resource utilization and expenditures of first-line treatments for multiple myeloma patients ineligible for transplant in Taiwan. PLoS One 2021; 16:e0252124. [PMID: 34038463 PMCID: PMC8153459 DOI: 10.1371/journal.pone.0252124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We aimed to provide real-world information on survival, health care resource utilization (HCRU), and expenditures related to various first lines of therapy (1LOTs) in newly diagnosed multiple myeloma (NDMM) patients who were transplant ineligible (TI). PATIENTS AND METHODS From the Taiwan National Health Insurance Database (2008-2016), we identified 1,511 NDMM-TI patients who had received 1LOT since June 2012. We categorized 1LOT regimens into four groups: bortezomib (V)+thalidomide (T), V, T, and non-V/T. Patients' characteristics were collected. The overall survival (OS), event-free survival (EFS), frequencies of HCRU (hospitalization, visiting outpatient and emergency departments), and related expenditures within one year after commencement of the 1LOT were evaluated and compared. RESULTS The mean age of the included patients was 71.3 (SD 10.7) years, and 40.4% of patients had a CCI score ≥3. Most patients (747; 49.4%) were in the V+T group and, after adjusting for covariates, had a significantly longer OS (median, 22.2 months) and EFS (9.1 months) than those in the T group (12.6 and 4.5 months, respectively) and the non-V/T group (12.2 and 3.2 months, respectively), but they were mostly comparable with patients in the V group (23.8 and 6.6 months, respectively). Compared to those in the V+T group, patients in the T and non-V/T groups had 29% and 39% fewer outpatient visits and 15% and 24% lower total expenditure, respectively. CONCLUSION Our real-world data consolidate evidence for the effectiveness of bortezomib-containing regimens as the 1LOT in NDMM-TI patients at the expense of more outpatient visits and higher total costs.
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Affiliation(s)
- Chih-Ning Cheng
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shang-Yi Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Wen Lien
- Takeda Pharmaceuticals Taiwan, Ltd, Taipei, Taiwan
| | | | - Fang-Ju Lin
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail:
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Tang CH, Hou HA, Huang KC, Qiu H, Liu Y. Treatment evolution and improved survival in multiple myeloma in Taiwan. Ann Hematol 2019; 99:321-330. [PMID: 31802187 PMCID: PMC6976543 DOI: 10.1007/s00277-019-03858-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 11/18/2019] [Indexed: 12/01/2022]
Abstract
The incidence of multiple myeloma (MM) is increasing worldwide, but the rate of increase is greatest in Asia. Few data describe the epidemiology and treatment of MM in Asia. Building on a cohort study from 2007 to 2012 using the Taiwan National Healthcare Insurance Research database, we extended our analysis to estimate the disease burden and treatment patterns of patients with MM in Taiwan through 2015. A further 1664 patients with newly diagnosed MM from 2013 to 2015 (total 4387 patients from 2007 to 2015) were enrolled and followed up until death or end of the observation period (December 31, 2016), whichever occurred first. The age distribution of the 2013–2015 cohort was similar to that for previous years, but there were fewer men (52.1% versus 58.0%), and more patients had renal impairment at diagnosis (19.7% versus 16.4%). From 2007 to 2015, crude annual incidences per 100,000 population of newly diagnosed MM increased from 1.74 to 2.48 and age-adjusted incidences from 1.41 to 1.65. Crude all-cause mortality rates increased over time. Case fatality decreased from 25.5 to 18.3% and median survival increased from 2.10 to 3.12 years. From 2007 to 2015, the percentage of patients receiving first-line therapy with novel agents increased from 0.4 to 89.4%, autologous stem cell transplantation doubled, and chemotherapy use decreased by 81%. Comprehensive national data covering 9 years of follow-up demonstrate continuing change in the disease burden, treatment, and survival of MM in Taiwan. Despite increased use of new treatments, MM remains largely incurable.
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Affiliation(s)
- Chao-Hsiun Tang
- School of Health Care Administration, Taipei Medical University, No.172-1 Keelung Road, Section 2, Taipei, 106, Taiwan
| | - Hsin-An Hou
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Zhongzheng Dist, Taipei City, 100, Taiwan
| | - Kuan-Chih Huang
- Janssen Research & Development Epidemiology, 319 DunHua South Road, Taipei City, 10669, Taiwan
| | - Hong Qiu
- Global Epidemiology, Janssen Research & Development, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Yanfang Liu
- Global Epidemiology, Janssen Research & Development, 2 Science Park Drive, Singapore, 118222, Singapore.
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Qian X, Chen H, Xia J, Wang J, Zhou X, Guo H. Real-World Clinical Outcomes in Elderly Chinese Patients with Multiple Myeloma: A Single-Center Experience. Med Sci Monit 2018; 24:5887-5893. [PMID: 30138301 PMCID: PMC6118163 DOI: 10.12659/msm.907588] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Recently, improvement in overall survival (OS) was demonstrated in elderly patients with multiple myeloma (MM). Our aim here was to analyze treatment outcomes in elderly Chinese patients with MM in real-world practice. Material/Methods This retrospective study enrolled 122 newly diagnosed MM patients ages 65–84 between January 2007 and December 2015 in a single hematology department. Results The median age of patients was 70.5 years. The median OS period of the entire cohort was 33 months; the 5-year OS estimate was 30.4%. The median OS of the 65–69, 70–74, and ≥75 years old groups were 43, 36, and 6 months, respectively. Female patients had better OS than male patients (40 and 28 months, P=0.026). Patients who received short-course bortezomib-containing regimens during their course of disease had a significantly longer median OS of 37 months compared with 28 months for patients without bortezomib treatment (P=0.029). Patients with age-adjusted Charlson comorbidity index (aaCCI) <5 showed longer median OS compared to those with aaCCI ≥5 (45 months vs. 23 months, P<0.001). Multivariate analysis revealed that male sex, high aaCCI, and LDH were independent prognostic factor for OS. Conclusions The marked survival improvement in the elderly patients was associated with the increased use of short-course bortezomib. CCI and LDH are important clinical prognostic factors for survival in elderly MM patients.
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Affiliation(s)
- Xifeng Qian
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu, China (mainland)
| | - Heng Chen
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu, China (mainland)
| | - Jun Xia
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu, China (mainland)
| | - Jing Wang
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu, China (mainland)
| | - Xin Zhou
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu, China (mainland)
| | - Hongfeng Guo
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu, China (mainland)
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Huang TC, Huang SY, Yao M, Lin CY, Hwang WL, Gau JP, Tan TD, Wang PN, Liu YC, Lin SC, Kao RH, Pei SN, Yu MS, Lin HY, Su YC, Chen CC, Li SS, Wu YY. Autologous stem cell transplantation in multiple myeloma: Post-transplant outcomes of Taiwan Blood and Marrow Transplantation Registry. J Formos Med Assoc 2018; 118:471-480. [PMID: 30119948 DOI: 10.1016/j.jfma.2018.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 06/01/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND/PURPOSE Multiple myeloma (MM) is a monoclonal plasma cell malignancy. The primary choice of treatment for MM is induction therapy followed by autologous stem cell transplantation (ASCT). This study aimed to analyze the treatment efficacy of ASCT in a Taiwanese cohort and evaluate possible prognostic factors. METHODS From the database of the Taiwan Blood and Marrow Transplantation registry, data on 396 patients with MM who underwent ASCT were reviewed. RESULTS The average age of participants was 54.8 years, and there were more men than women (57.6% vs. 42.4%). Most patients were diagnosed with IgG-type myeloma (52.4%), followed by IgA-type (23.2%) and light-chain type (21.4%). Patients with Durie Salmon Staging System (DSS) III disease accounted for 61.9% of the study cohort, while 23.7% had stage II and 14.4% had stage I disease. The median progression-free survival (PFS) and overall survival (OS) after ASCT were 46.5 months and 70.4 months, respectively. DSS III was a poor prognostic factor affecting both PFS and OS with a duration of 35.9 months and 69.0 months, respectively, compared with the other two stages (p = 0.006 and p = 0.03, respectively). In addition, patients with better treatment response before ASCT had better PFS and OS compared with those who did not show a response (both p < 0.0001). The overall incidence of organ toxicities associated with transplantation was low. CONCLUSION In conclusion, our cohort showed that myeloma patients with early DSS and better treatment response before ASCT had better long-term survival outcomes.
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Affiliation(s)
- Tzu-Chuan Huang
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shang-Yi Huang
- Hematology-Oncology Section, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming Yao
- Hematology-Oncology Section, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Yuan Lin
- Division of Hematology and Oncology, Department of Medicine, China Medical University Hospital, Taiwan
| | - Wen-Li Hwang
- Division of Hematology/Medical Oncology, Taichung Veterans General Hospital, Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology, Taipei Veterans General Hospital, National Yang-Ming University, Taiwan
| | - Tran-Der Tan
- Department of Hematology and Medical Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taiwan
| | - Po-Nan Wang
- Division of Hematology, Chang Gung Medical Foundation, Linkou Branch, Taiwan
| | - Yi-Chang Liu
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Chiang Lin
- Division of Oncology-Hematology, Far Eastern Memorial Hospital, Taiwan
| | - Ruey-Ho Kao
- Department of Hematology and Oncology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Sung-Nan Pei
- Kaohsiung Chang-Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ming-Sun Yu
- Hematology/Oncology Division, Dept. of Medicine Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsuan-Yu Lin
- Changhua Christian Hospital, Internal Medicine Department, Hematology and Oncology Division, Taiwan
| | - Yung-Cheng Su
- Division of Hemato-Oncology, Taipei Medical University-Shuang Ho Hospital, Taiwan
| | - Chih-Cheng Chen
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Sin-Syue Li
- Division of Hematology/Oncology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yi-Ying Wu
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Myeloma in the Real World: What Is Really Happening? CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 17:133-144.e1. [PMID: 28153487 DOI: 10.1016/j.clml.2016.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/16/2016] [Accepted: 12/14/2016] [Indexed: 12/25/2022]
Abstract
Multiple myeloma (MM) is the second most common hematologic malignancy and is predominantly a disease of the elderly. In the past 2 decades, a range of new therapeutic options have become available, leading to improvements in patient outcomes, including both attainment of remission and overall survival. These improved outcomes have heralded a paradigm shift from a palliative approach toward more active management, including the use of sequential therapies, with the goal of prolonging progression-free and overall survival and preserving organ function to enable delivery of further therapy at relapse. Until now, most outcome data for MM have come from clinical trials, with few reports available on patients treated outside the clinical trial setting-in the "real world." Clinical trials are routinely undertaken in specialist centers, and extrapolation of these trial data to broader clinical practice might not accurately reflect "real-world" patient outcomes. Optimal management of MM is of key importance for positive patient outcomes, and further scrutiny of the efficacy and safety of the various reported therapies and how clinical trial findings are being translated or applied in the real-world management of MM is required. In the present review, we have described the minimal published evidence available through a comprehensive published data search of MEDLINE using the OvidSP interface on the management and outcomes of MM outside the setting of clinical trials, including evidence on the uptake of new therapies and their efficacy and tolerability in standard practice. Clinical registries might be able to help provide these data in the future.
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Chen JH, Chung CH, Wang YC, Hsu SN, Huang WY, Chien WC. Prevalence and Mortality-Related Factors of Multiple Myeloma in Taiwan. PLoS One 2016; 11:e0167227. [PMID: 27907052 PMCID: PMC5132205 DOI: 10.1371/journal.pone.0167227] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/10/2016] [Indexed: 11/22/2022] Open
Abstract
In this retrospective cohort study based in Taiwan, we reported the current epidemiology of patients with multiple myeloma and analyzed the factors affecting mortality. We identified 7285 patients with newly diagnosed multiple myeloma (MM) between 1997 and 2013 in Taiwan. Privileges data from the National Health Institute Research Database was used, as it is made readily available to the public in electronic format for research purposes. From 1997 to 2013, the average incidence of MM per 100,000 people was 1.83. The mortality accounted for an average of 0.44 per 100,000 deaths. In all 7285 inpatients with MM, the proportion of male patients was greater than that of female (59.90% vs. 40.10%); the mean age was 68.71 years with the proportion of those >55 years of age was 85.11%; and the proportion of a catastrophic illness was 66.51%. The death risk of the inpatient dialysis group was 3.044 times that of patients without dialysis (P <0.001). Moreover, the risk of death to men in the hospital setting was 1.162 times that of women (P = 0.012), and in the group of patients aged >55 years, the risk of in-hospital death was 1.511 times more than that in those aged ≤55 years (P <0.001). The risk of hospital death due to catastrophic illness was 1.347 times that of a non-catastrophic illness (P <0.001). Male patients and those >55 years of age had the most common prevalence of MM in Taiwan. Hemodialysis treatment, male sex, old age, and catastrophic illness were independent predictors of hospital mortality in patients with MM.
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Affiliation(s)
- Jia-Hong Chen
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention & Safety Promotion Association, National Defense Medical Center, Taipei, Taiwan
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shun-Neng Hsu
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Yen Huang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- National Defense Medical Center, Tri-Service General Hospital, Department of Medical Research, Neihu District, Taipei City, Taiwan
- National Defense Medical Center, School of Public Health, Neihu District, Taipei City, Taiwan
- * E-mail:
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Chen YK, Han SM, Yang Y, Lin TH, Tzeng HE, Chang KH, Hwang WL, Teng CLJ. Early mortality in multiple myeloma: Experiences from a single institution. Hematology 2016; 21:392-8. [DOI: 10.1080/10245332.2015.1101969] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Yeh-Ku Chen
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taiwan
| | - Shao-Min Han
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taiwan
| | - Youngsen Yang
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taiwan
| | - Tseng-Hsi Lin
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taiwan
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taiwan
- Department of Medicine, Chung Shan Medical University, Taiwan
| | - Huey-En Tzeng
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taiwan
| | - Kuang-Hsi Chang
- Department of Medical Research and Education, Taichung Veterans General Hospital, Taiwan
| | - Wen-Li Hwang
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taiwan
| | - Chieh-Lin Jerry Teng
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taiwan
- Department of Medicine, Chung Shan Medical University, Taiwan
- Department of Life Science, Tunghai University, Taiwan
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