Jyothi Dodlapati, James A Hall, Pruthali Kulkarni, Kelsey B Reely, Amit A Nangrani, Laurel A Copeland
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引用次数: 0
Abstract
Background: Multiple myeloma (MM) accounts for 1% to 2% of all cancers. Exposure to the pesticide Agent Orange (AO) has been established as a potential risk factor for the development of monoclonal gammopathy of undetermined significance (MGUS) and, subsequently, MM in Vietnam War veterans.
Methods: This study explored variation in survival related to AO exposure, transformation from MGUS to MM, and covariates. Vietnam War veterans with MM or MGUS were identified in Veterans Health Administration (VHA) health records data. Cox proportional hazards models analyzed survival as a function of AO, race, ethnicity, body mass index, nicotine dependence, alcohol use disorder, Charlson Comorbidity Index, and treatment. Autologous hematopoietic cell transplantation for MM was defined by procedure codes.
Results: In the VHA 16,366 patients were identified: 11,112 patients diagnosed with MGUS and 7261 with MM during fiscal years 2010 to 2015 were identified; 12% (n = 2007) had both diagnoses. No statistically significant difference in the rate of transformation from MGUS to MM in the AO exposed and AO not exposed groups was found. In survival models, AO exposure was associated with slightly lower mortality. Alcohol use disorder, nicotine dependence, older age, and greater comorbidity burden increased mortality risk. Black race, female sex, obesity/overweight, and hematopoietic cell transplantation for patients with MM were protective factors. AO exposure was associated with decreased mortality for both MM/MGUS groups. Transformation increased mortality risk for patients with MGUS and decreased mortality risk for patients with MM.
Conclusions: Because AO exposure is a nonmodifiable risk factor, focus should be placed on modifiable risk factors (eg, nicotine dependence, alcohol and drug use disorders, underlying comorbid conditions) as these were associated with worse outcomes. Future studies should examine the correlation of AO exposure, cytogenetics, and clinical outcomes in these veterans to best identify their disease course and optimize their care in the latter part of their life.
背景:多发性骨髓瘤(MM多发性骨髓瘤(MM)占所有癌症的 1%至 2%。暴露于杀虫剂橙剂(AO)已被确定为越战老兵发生意义未定的单克隆丙种球蛋白病(MGUS)以及随后发生多发性骨髓瘤的潜在风险因素:本研究探讨了与暴露于 AO、从 MGUS 转化为 MM 以及协变量有关的存活率变化。从退伍军人健康管理局(VHA)的健康记录数据中确定了患有MM或MGUS的越战退伍军人。Cox比例危险模型分析了存活率与AO、种族、民族、体重指数、尼古丁依赖、酒精使用障碍、Charlson合并症指数和治疗的关系。治疗 MM 的自体造血细胞移植由手术代码定义:结果:在美国退伍军人协会(VHA)中发现了 16,366 名患者:2010至2015财年期间,有11112名患者被诊断为MGUS,7261名患者被诊断为MM;12%的患者(n = 2007)同时被诊断为这两种疾病。暴露于氧化亚氮组和未暴露于氧化亚氮组从 MGUS 转化为 MM 的比率在统计学上没有发现明显差异。在生存模型中,暴露于氧化亚氮与稍低的死亡率相关。酗酒、尼古丁依赖、年龄较大和合并症较多增加了死亡风险。黑种人、女性、肥胖/超重和 MM 患者接受造血细胞移植是保护因素。接触 AO 与 MM/MGUS 两组死亡率的降低有关。转化增加了MGUS患者的死亡风险,降低了MM患者的死亡风险:结论:由于暴露于 AO 是一种不可改变的风险因素,因此应重点关注可改变的风险因素(如尼古丁依赖、酒精和药物使用障碍、潜在的合并症),因为这些因素与较差的预后相关。未来的研究应检查这些退伍军人的AO暴露、细胞遗传学和临床结果之间的相关性,以最好地确定他们的病程并优化他们后半生的护理。