Originally published as JCO Early Release 10.1200/JCO.2006.09.0100 on April 9 2007

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Patterns of Survival in Multiple Myeloma: A Population-Based Study of Patients Diagnosed in Sweden From 1973 to 2003

Sigurdur Yngvi Kristinsson, Ola Landgren, Paul W. Dickman, Åsa Rangert Derolf, Magnus Björkholm

From the Division of Hematology, Department of Medicine, and Department of Medical Epidemiology and Biostatistics, Karolinska University Hospital and Institutet, Stockholm, Sweden; and Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD

Address reprint requests to Magnus Björkholm, MD, Division of Hematology, Department of Medicine, Karolinska University Hospital, SE-171 76 Stockholm, Sweden; e-mail: magnus.bjorkholm{at}karolinska.se

Purpose To define patterns of survival among all multiple myeloma (MM) patients diagnosed in Sweden during a 30-year period.

Patients and Methods A total of 14,381 MM patients (7,643 males; 6,738 females) were diagnosed in Sweden from 1973 to 2003 (median age, 69.9 years; range 19 to 101 years). Patients were categorized into six age categories and four calendar periods (1973 to 1979, 1980 to 1986, 1987 to 1993, and 1994 to 2003). We computed relative survival ratios (RSRs) as measures of patient survival.

Results One-year survival improved (P < .001) over time in all age groups and RSRs were 0.73, 0.78, 0.80, and 0.82 for the four calendar periods; however, improvement in 5-year (P < .001) and 10-year (P < .001) RSR was restricted to patients younger than 70 years and younger than 60 years, respectively. For the first time, in analyses restricted to MM patients diagnosed at age younger than 60 years, we found a 29% (P < .001) reduced 10-year mortality in the last calendar period (1994 to 2003) compared with the preceding calendar period (1987 to 1993). Females with MM had a 3% (P = .024) lower excess mortality than males.

Conclusion One-year MM survival has increased for all age groups during the last decades; 5-year and 10-year MM survival has increased in younger patients (younger than 60 to 70 years). High-dose melphalan with subsequent autologous stem-cell transplantation, thalidomide, and a continuous improvement in supportive care measures are probably the most important factors contributing to this finding. New effective agents with a more favorable toxicity profile are needed to improve survival further, particularly in the elderly.

published online ahead of print at www.jco.org on April 9, 2007.

Supported by grants from the Swedish Cancer Society, Stockholm County Council, and the Karolinska Institutet Foundations.

Presented in part at the 46th Annual Meeting of the American Society of Hematology, December 4-7, 2004, San Diego, CA; and the 9th Annual Congress of the European Hematology Association, June 10-13, 2004, Geneva, Switzerland.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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