rev bras hematol hemoter. 2015;37(5):354–355
w w w . r b h h . o r g
Revista
Brasileira
de
Hematologia
e
Hemoterapia
Brazilian
Journal
of
Hematology
and
Hemotherapy
Letter
to
the
Editor
Clinical
and
epidemiological
features
of
multiple
myeloma
patients
from
a
low
socio-economic
region
of
Brazil
DearEditor,
Multiple myeloma(MM) represents 1%ofall newcases of cancerworldwide.1 TheInternational MyelomaFoundation
estimatesthatabout30,000MMpatientsarecurrentlyunder treatmentinBrazil.Sincefewstudieshavereportedthe clin-icalandepidemiologicalfeaturesofMMinthiscountry,2,3we
aimtocontributetotheclinicalpanoramaofthediseaseby describingaseriesof65patients(medianage:64years;range: 35–80years)diagnosedwithMMbetween2006and2014at theHospitaldaLIGA(n=55)andOncoclínicaSãoMarcos(n=10), Natal, RN. Patients diagnosed with monoclonal gammopa-thyofundeterminedsignificance,asymptomaticMM,POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonalgammopathy,andskinchanges),solitary plasma-cytoma,andprimaryplasmacellleukemiawereexcluded.The majorityofmyelomaproteinswereoftheIgGisotype(69.2%). TheKappalightchainwasassociatedwiththeheavychain isotypesin64.7%ofcases.MostpatientswereinstageIIIAof theDurieandSalmon(DS)classification(80.4%)andinStages I,IIandIIIoftheInternationalStagingSystem(ISS)(41.7%, 22.9%and35.4%,respectively).Thirty-threepatients(50.7%) were submitted to conventional chemotherapy based on cyclophosphamide,thalidomideanddexamethasone(CTD), with16ofthemundergoingautologoushematopoieticstem cell transplantations.Sixteen patients (24.6%)were treated witha melphalan,prednisone and thalidomide (MPT) pro-tocol. Eight(12.3%)patients were treated withthalidomide withdexamethasoneandeight(12.3%)withvincristine, dox-orubicin and dexamethasone (VAD). Sixteen patients took bortezomibassecond linetreatmentafterdisease progres-sion.
In our cohort, the clinical presentation and response totreatment revealedgender-related differencesnot found worldwide,withwomenbeingmorefrequentlyaffectedthan men(genderratioM/F=0.6)andexhibitinglowercreatinine levels at diagnosis than men (<1.3mg/dL) (p-value=0.032). These epidemiological and clinical characteristics are not
similar to the disease descriptions in the more developed southernregionsofBrazil.2,3 Infact,inmostcountries,MM
ismorefrequentinmenthaninwomen.4,5Thecausesofthe
genderbiashereinreported,whetherrelatedtoreferral(for instance,duetowomen’shealthcampaignswhichhavebeen intensifiedinBraziloverthelastdecades)orbiological charac-teristicsofthepopulation,arenotevidentandwarrantfurther studies. Regarding biological factors,Boyd et al.6 analyzed
cytogeneticalterations inalargeMMcohortandsuggested thatgenderdifferencesareinfluencedbytheprimarygenetic events,withimmunoglobulintranslocationsbeingmore com-mon inwomen andhyperdiploidyinmen.Inthe southern regionsofBrazil,wheregeneticalterationshavebeenstudied inMM,nosuchbiaswasdescribed.7
Plasmacytoma wasdefined asbone and extramedullary tumorsthatwereidentifieduponphysicalexaminationand byimagingstudies,includingacompleteX-rayinvestigation, computedtomographyscanandmagneticresonanceimaging. Plasmacytomawasdetectedin43.4%(23/53)ofMMpatients atdiagnosis.Thethoraciccurveofthevertebralcolumnwas themostcommonsite(40%),followedbythelumbarspine, femur,skullandpelvis.Thefrequencyofplasmacytomawas higherthanthatreportedworldwide,8,9butsimilartoanother
reportfromBrazil.10Althoughnotbeingconsideredamarker
ofadvanceddiseaseorprogression,sinceitcanoccuratany stageofmyeloma,plasmacytomahasbeenmorefrequently foundinpatients withhighertumorburden,9,10 whichcan
accountfortheincreasedincidenceofplasmacytomainour study.
rev bras hematol hemoter. 2 0 1 5;37(5):354–355
355
95%CI:0–15monthsvs. 37months; 95%CI:16–57months – p-value=0.011) and OS (mean time: 16 months; 95% CI: 3.1–21.8monthsvs.81months;95%CI:24.5–137.4months–
p-value=0.006).
Weacknowledgethe limitation imposed bythe reduced numberofpatients;however,ourresultsinaparticularseries ofMMpatientspointtotheneedofimprovingstrategiesfor earlydiagnosisandprognosisofMMinlessprivilegedsettings.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
Acknowledgements
WethankMarcos Leãoforprovidingsamplesand thestaff of Hospital da Liga for technical support. This work was supportedby the Brazilian Instituto Nacional de Ciência e Tecnologia (INCT) para Controle do Câncer (Grants CNPq 573806/2008-0andFAPERJE26/170.026/2008)(Brazil).
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1. KyleRA,GreippRP.Plasmacelldyscrasias:currentstatus.Crit RevOncolHematol.1988;8(2):93–152.
2. HungriaVT,MaiolinoA,MartinezG,ColleoniGW,CoelhoEO, RochaL,etal.ConfirmationoftheutilityoftheInternational StagingSystemandidentificationofauniquepatternof diseaseinBrazilianpatientswithmultiplemyeloma. Haematologica.2008;93(5):791–2.
3. SilvaP,BrandãoK,PintoP,FariaR,ClementinoN,SilvaC, etal.Mielomamúltiplo:característicasclínicaselaboratoriais aodiagnósticoeestudoprognóstico.RevBrasHematol Hemoter.2009;31(2):63–8.
4. SantM,MinicozziP,MounierM,AndersonLA,BrennerH, HolleczekB,etal.Survivalforhaematologicalmalignancies inEuropebetween1997and2008byregionandage:resultsof EUROCARE-5,apopulation-basedstudy.LancetOncol. 2014;15(9):931–42.
5. RaabMS,PodarK,BreitkreutzI,RichardsonPG,AndersonKC. Multiplemyeloma.Lancet.2009;374(9686):
324–39.
6.BoydKD,RossFM,ChiecchioL,DagradaG,KonnZJ,Tapper WJ,etal.Genderdisparitiesinthetumorgeneticsandclinical outcomeofmultiplemyeloma.CancerEpidemiolBiomarkers Prev.2011;20(8):1703–7.
7.LinardiCC,MartinezG,VellosoED,LealAM,KumedaCA, BuccheriV,etal.Evaluationofchromosomalabnormalitiesby cIg-FISHandassociationwithproliferativeandapoptotic indexesinmultiplemyeloma.BrazJMedBiolRes. 2012;45(11):1074–9.
8.VarettoniM,CorsoA,PicaG,MangiacavalliS,PascuttoC, LazzarinoM.Incidence,presentingfeaturesandoutcomeof extramedullarydiseaseinmultiplemyeloma:alongitudinal studyon1003consecutivepatients.AnnOncol.
2010;21(2):325–30.
9.IriuchishimaH,SaitohT,HandaH,IsodaA,MatsumotoM, SawamuraM,etal.Anewstagingsystemtopredictprognosis ofpatientswithmultiplemyelomainaneraofnovel therapeuticagents.EurJHaematol.2015;94(2):145–51.
10.CrusoeEdeQ,HigashiF,PadilhaMP,MirandaEC,QueroAA, AlmeidaM,etal.Outcomesofautologoustransplantationfor multiplemyelomaaccordingtodifferentinductionregimens. RevBrasHematolHemoter.2014;36(1):19–24.
CarolinaMinnicellia,∗,JamesFarleyRafaelMacielb,
RocioHassanc, TelmaMariaAraújoMouraLemosa
aUniversidadeFederaldoRioGrandedoNorte(UFRN),Natal,RN,
Brazil
bLigaNorteriograndensecontraoCâncer(LIGA),Natal,RN,Brazil cInstitutoNacionaldoCâncer(INCA),RiodeJaneiro,RJ,Brazil
∗Correspondingauthorat:DepartmentofClinicalAnalysisand
Toxicology, Universidade Federal do Rio Grande do Norte (UFRN),RuaGenGustavoCordeiro,s/n,Petropolis,59010-180 Natal,RN,Brazil.
E-mailaddress:[email protected](C.Minnicelli).
Received13March2015 Accepted8May2015
1516-8484/©2015Associac¸ãoBrasileiradeHematologia, HemoterapiaeTerapiaCelular.PublishedbyElsevierEditora Ltda.Allrightsreserved.
http://dx.doi.org/10.1016/j.bjhh.2015.05.007
