TY - JOUR
T1 - Risk of stroke in patients with newly diagnosed multiple myeloma
T2 - a retrospective cohort study
AU - Lee, Gin Yi
AU - Lee, Yu Ting
AU - Yeh, Chiu Mei
AU - Hsu, Pei
AU - Lin, Ting Wei
AU - Gau, Jyh Pyng
AU - Yu, Yuan Bin
AU - Hsiao, Liang Tsai
AU - Tzeng, Cheng Hwai
AU - Chiou, Tzeon Jye
AU - Liu, Jin Hwang
AU - Liu, Yao Chung
AU - Liu, Chia Jen
N1 - Funding Information:
This study was supported by unrestricted research grants from Taipei Veterans General Hospital (V105B-016 and V105E10-002-MY2-1), the Ministry of Science and Technology (MOST 104-2314-B-075-085-MY2), Taiwan Clinical Oncology Research Foundation, Szu-Yuan Research Foundation of Internal Medicine, and Chong Hin Loon Memorial Cancer and Biotherapy Research Center, at National Yang-Ming University. The authors declare that they have no competing interests. YCL and CJL were responsible for the accuracy of analysis and the integrity of the cohort. GYL and YTL contributed equally and are the first authors. GYL, YTL, YCL, and CJL designed the study. CJL and CMY performed the statistical analysis. GYL, YTL, YCL, and CJL interpreted the results. GYL and YTL drafted the manuscript. PH, TWL, JPG, YBY, LTH, CHT, TJC, and JHL made critical revisions to the manuscript. TWL, JPG, YBY, LTH, CHT, TJC, and JHL provided administrative, technical, and material support. All authors approved the final version for submission.
Publisher Copyright:
Copyright © 2016 John Wiley & Sons, Ltd.
PY - 2017/12
Y1 - 2017/12
N2 - Cerebrovascular events are a common complication among patients with cancer, increasing morbidity and mortality. However, the association between multiple myeloma and cerebrovascular events remains unclear. We therefore investigated multiple myeloma patients' risk factors for stroke to devise a better stroke-prevention strategy. This study includes consecutive patients 20 years and older who were newly diagnosed with symptomatic multiple myeloma at Taipei Veterans General Hospital, a tertiary medical center, between January 1, 2002 and December 31, 2014. The primary outcome was stroke development. Patients with head injuries, brain tumors, brain parenchymal invasions, or antecedent malignancies were excluded. Hazard ratios (HRs) of stroke risk factors for multiple myeloma patients were estimated by Cox proportional regression analysis. Overall, 395 patients with a median age of 70 years were investigated. In the median follow-up period of 18 months, cerebrovascular events occurred in 16 patients, including 10 ischemic strokes and 6 hemorrhagic strokes. The 5-year estimated cumulative incidence rate was 7.45%. In the multivariate analysis, the κ light chain isotype (adjusted HR, 8.37; 95% confidence interval [CI], 1.91-39.8), previous cerebrovascular accidents (adjusted HR, 5.16; 95% CI, 1.48-17.9), and serum creatinine > 2 mg/dL (adjusted HR, 4.21; 95% CI, 1.10-16.0) were identified as independent risk factors for stroke. Subgroup analysis showed that atrial fibrillation (adjusted HR, 8.07) and previous cerebrovascular accident (adjusted HR, 4.89) are significant risk factors for ischemic stroke. Serum creatinine > 2 mg/dL (adjusted HR, 30.6) and previous cerebrovascular accident (adjusted HR, 13.9) are significant for hemorrhagic stroke. Moreover, therapeutic strategies for multiple myeloma were not associated with stroke in our study. This study demonstrates that risk of stroke increases in myeloma patients with a κ light chain isotype, previous cerebrovascular events, and renal impairment. Further prospective clinical studies to clarify the relationship between multiple myeloma and stroke are warranted.
AB - Cerebrovascular events are a common complication among patients with cancer, increasing morbidity and mortality. However, the association between multiple myeloma and cerebrovascular events remains unclear. We therefore investigated multiple myeloma patients' risk factors for stroke to devise a better stroke-prevention strategy. This study includes consecutive patients 20 years and older who were newly diagnosed with symptomatic multiple myeloma at Taipei Veterans General Hospital, a tertiary medical center, between January 1, 2002 and December 31, 2014. The primary outcome was stroke development. Patients with head injuries, brain tumors, brain parenchymal invasions, or antecedent malignancies were excluded. Hazard ratios (HRs) of stroke risk factors for multiple myeloma patients were estimated by Cox proportional regression analysis. Overall, 395 patients with a median age of 70 years were investigated. In the median follow-up period of 18 months, cerebrovascular events occurred in 16 patients, including 10 ischemic strokes and 6 hemorrhagic strokes. The 5-year estimated cumulative incidence rate was 7.45%. In the multivariate analysis, the κ light chain isotype (adjusted HR, 8.37; 95% confidence interval [CI], 1.91-39.8), previous cerebrovascular accidents (adjusted HR, 5.16; 95% CI, 1.48-17.9), and serum creatinine > 2 mg/dL (adjusted HR, 4.21; 95% CI, 1.10-16.0) were identified as independent risk factors for stroke. Subgroup analysis showed that atrial fibrillation (adjusted HR, 8.07) and previous cerebrovascular accident (adjusted HR, 4.89) are significant risk factors for ischemic stroke. Serum creatinine > 2 mg/dL (adjusted HR, 30.6) and previous cerebrovascular accident (adjusted HR, 13.9) are significant for hemorrhagic stroke. Moreover, therapeutic strategies for multiple myeloma were not associated with stroke in our study. This study demonstrates that risk of stroke increases in myeloma patients with a κ light chain isotype, previous cerebrovascular events, and renal impairment. Further prospective clinical studies to clarify the relationship between multiple myeloma and stroke are warranted.
KW - arterial thrombosis
KW - cerebrovascular event
KW - multiple myeloma
KW - stroke
KW - κ light chain isotype
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U2 - 10.1002/hon.2340
DO - 10.1002/hon.2340
M3 - Article
C2 - 27545592
AN - SCOPUS:84994525807
SN - 0278-0232
VL - 35
SP - 726
EP - 733
JO - Hematological Oncology
JF - Hematological Oncology
IS - 4
ER -
