The impact of prior malignancies on second malignancies and survival in MM patients: a population-based study

Abstract

In the present study, we aimed to evaluate 2 hypotheses. First, we hypothesize that prior malignancy is a proxy for genetic susceptibility that could be a risk factor for subsequent malignancy development in multiple myeloma (MM) patients. Second, we hypothesize that survival after MM is influenced by a prior malignancy. All patients diagnosed with MM from 1 January 1973 to 31 December 2010 were identified from the Swedish Cancer Register. Cox regression model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) where prior malignancy was compared in MM patients who developed a subsequent malignancy and MM patients who did not. In another Cox regression model, survival was compared in MM patients with and without a prior malignancy diagnosis. A total of 19 791 patients were diagnosed with MM. Patients with a prior malignancy diagnosis had a significantly increased risk of developing a subsequent malignancy compared with MM patients without (HR 1.42, 95% CI 1.23-1.65, P < .001). MM patients with a prior malignancy diagnosis had a significant 1.21-fold increased risk of death (95% CI 1.115-1.26, P < .001) compared with MM patients without. MM patients with 2 or more prior malignancy diagnoses had a 1.34-fold increased risk of death (95% CI 1.19-1.52, P < .001). In this large population-based study, we report that prior malignancy increases the risk of subsequent malignancy development in MM patients. Furthermore, we found that prior malignancy negatively impacts survival and that >1 prior malignancy reduces survival even further.

Graphical abstract

Figure 1.

Number of prior and subsequent malignancies in MM patients according to malignancy types. Group letters: A, ear, nose, and throat; B, gastrointestinal; C, respiratory; D, bone and cartilage; E, melanoma; F, nonmelanoma skin cancer; G, soft tissue and mediastinal; H, breast malignancy; I, female reproductive; J, male reproductive; K, kidney and urinary tract; L, nervous system; M, endocrine; N, unspecified tumors; O, hematological; and P, eye tumors.

Figure 2.

Survival in MM patients with and without prior malignancies. Survival was compared between patients with no prior malignancy, 1 prior malignancy, and 2 or more prior malignancies.