Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 1;15(17):4359.
doi: 10.3390/cancers15174359.

Outcome of Second Primary Malignancies Developing in Multiple Myeloma Patients

Irit Avivi  1 , David H Vesole  2 , Julio Davila-Valls  3 , Lidia Usnarska-Zubkiewicz  4 , Magdalena Olszewska-Szopa  4 , Vibor Milunovic  5 , Bartłomiej Baumert  6 , Bogumiła Osękowska  6 , Anna Kopińska  7 , Massimo Gentile  8 , Borja Puertas-Martinez  9 , Paweł Robak  10 , Edvan Crusoe  11 , Luis Gerardo Rodriguez-Lobato  12 , Małgorzata Gajewska  13 , Gergely Varga  14 , Michel Delforge  15 , Yael Cohen  1 , Alessandro Gozzetti  16 , Camila Pena  17 , Chaim Shustik  18 , Gabor Mikala  19 , Klara Zalac  20 , H Denis Alexander  21 , Peter Barth  22 , Katja Weisel  23 , Joaquín Martínez-López  24 , Anna Waszczuk-Gajda  25 , Mateusz Krzystański  26 , Artur Jurczyszyn  27
Affiliations

Outcome of Second Primary Malignancies Developing in Multiple Myeloma Patients

Irit Avivi et al. Cancers (Basel). .

Abstract

Background: There is an increased risk of second primary malignancies (SMPs) in patients with multiple myeloma (MM). This multinational 'real-world' retrospective study analyzed the characteristics and outcomes of MM patients that developed SPMs.

Results: 165 patients were analyzed: 62.4% males; 8.5% with a prior cancer; 113 with solid SPMs, mainly ≥stage 2; and 52 with hematological SPM (hemato-SPM), mainly MDS/AML. Patients with hemato-SPM were younger (p = 0.05) and more frequently had a prior AutoHCT (p = 0.012). The time to SPM was shorter in the older (>65 years) and more heavily pretreated patients. One hundred patients were actively treated at the time of SPM detection. Treatment was discontinued in 52, substituted with another anti-MM therapy in 15, and continued in 33 patients. Treatment discontinuation was predominant in the patients diagnosed with hemato-SPM (76%). The median OS following SPM detection was 8.5 months, and the main cause of death was SPM. A poor ECOG status predicted a shorter OS (PS 3 vs. 0, HR = 5.74, 2.32-14.21, p < 0.001), whereas a normal hemoglobin level (HR = 0.43, 0.19-0.95, p = 0.037) predicted longer OS.

Conclusions: With the continuing improvement in OS, a higher proportion of MM patients might develop SPM. The OS following SPM diagnosis is poor; hence, frequent surveillance and early detection are imperative to improve outcomes.

Keywords: SPM; multiple myeloma; second primary malignancy; therapy.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Time to second primary malignancy depending on the factors selected (univariate analysis). Factors in order: age; NIDMM (non-insulin-dependent diabetes); B2M (beta-2 microglobulin); platelet count; prior history of cancer; prior myeloma therapy; comorbidities; hemoglobin levels. SPM—second primary malignancy.
Figure 2
Figure 2
(A) Median overall survival following MM diagnosis in all SPM patients. OS—overall survival; MM—multiple myeloma. (B) Median overall survival following second primary malignancy, excluding patients that died of myeloma. OS—overall survival; MM—multiple myeloma; SPM—second primary malignancy.
Figure 3
Figure 3
Overall survival depending on the factors selected (univariate analysis). Factors in order: creatinine; hemoglobin level; SPM (second primary malignancy) type; ECOG—Eastern Cooperative Oncology Group grade; prior maintenance. OS—overall survival.
See this image and copyright information in PMC

References

    1. Brink M., Minnema M.C., Visser O., Levin M.D., Posthuma E.F.M.W., Broijl A., Sonneveld P., van der Klift M., Roeloffzen W.W.H., Westerman M., et al. Increased mortality risk in multiple-myeloma patients with subsequent malignancies: A population-based study in the Netherlands. Blood Cancer J. 2022;12:41. doi: 10.1038/s41408-022-00640-6. - DOI - PMC - PubMed
    1. Maclachlan K., Diamond B., Maura F., Hillengas J., Turesson I., Landgren C.O., Kazandjian D. Second malignancies in multiple myeloma; emerging patterns and future directions. Best Pract. Res. Clin. Haematol. 2020;33:101144. doi: 10.1016/j.beha.2020.101144. - DOI - PMC - PubMed
    1. Krishnan A.Y., Mei M., Sun C.L., Thomas S.H., Teh J.B., Kang T., Htut M., Somlo G., Sahebi F., Forman S.J., et al. Second primary malignancies after autologous hematopoietic cell transplantation for multiple myeloma. Biol. Blood Marrow Transpl. 2013;19:260–265. doi: 10.1016/j.bbmt.2012.09.023. - DOI - PMC - PubMed
    1. Musto P., Anderson K.C., Attal M., Richardson P.G., Badros A., Hou J., Comenzo R., Du J., Durie B.G.M., Miguel J.S., et al. Second primary malignancies in multiple myeloma: An overview and IMWG consensus. Ann. Oncol. 2017;28:228–245. doi: 10.1093/annonc/mdw606. - DOI - PubMed
    1. Rosenberg A.S., Brunson A., Tuscano J., Jonas B.A., Hoeg R., Wun T., Keegan T.H.M. Effect of autologous hematopoietic stem cell transplant on the development of second primary malignancies in multiple myeloma patients. Blood Cancer J. 2021;11:5. doi: 10.1038/s41408-020-00400-4. - DOI - PMC - PubMed