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Low uptake of upfront autologous transplantation for myeloma in a jurisdiction with universal health care coverage: a population-based patterns of care study in Australia
journal contribution
posted on 2014-02-01, 00:00 authored by N Wong Doo, M Coory, Vicki WhiteVicki White, S J Harrison, H M Prince, J L Millar, M Dimech, G G Giles, IMPROVE ProjectBACKGROUND: Guidelines for the management of symptomatic multiple myeloma (MM) recommend upfront autologous stem cell transplantation (ASCT) for transplant-eligible patients. PATIENTS AND METHODS: Using population-based data, we examined the characteristics of transplant-eligible patients who do not undergo upfront ASCT. Altogether, 686 newly diagnosed MM cases were identified through the population-based central cancer registry in Victoria, Australia from 2008 to 2009. We performed a detailed review of clinical notes and follow-up for at least 12 months after diagnosis for a subset of 225 patients who were aged < 70 years at diagnosis and had symptomatic MM. RESULTS: Of these 225 patients, 123 (55%) proceeded to receive upfront ASCT. Patient and disease factors associated with not receiving upfront ASCT were the presence of severe medical comorbidities, MM-associated renal impairment, and initial referral to a medical oncologist rather than a hematologist. Place of residence (rural vs. metropolitan) was not significant. Of 121 patients aged < 65 years at diagnosis who had minor or no comorbidities, only 75 (62%) proceeded to upfront ASCT. CONCLUSION: A substantial percentage of apparently transplant-eligible patients with newly diagnosed MM do not proceed to upfront ASCT. Community practice appears to diverge from clinical guidelines. The reasons for this divergence require further study but reasons may include perceptions of toxicity vs. benefits of upfront ASCT.
History
Journal
Clinical Lymphoma, Myeloma and LeukemiaVolume
14Issue
1Pagination
61 - 67Publisher
ElsevierLocation
New York, N.Y.Publisher DOI
ISSN
2152-2650eISSN
2152-2669Language
engPublication classification
C Journal article; C1.1 Refereed article in a scholarly journalCopyright notice
2014, ElsevierUsage metrics
Categories
Keywords
EpidemiologyMultiple myelomaStem cell transplantationAgedAustraliaDelivery of Health CareFemaleHumansInsurance CoverageMaleMiddle AgedTransplantation, AutologousScience & TechnologyLife Sciences & BiomedicineOncologyHematologySTEM-CELL TRANSPLANTATIONHIGH-DOSE THERAPYMULTIPLE-MYELOMACHEMOTHERAPYSURVIVALTRIALMOBILIZATIONMANAGEMENTYOUNGERIMPACTIMPROVE ProjectEpidemiologyCancer Therapy (excl. Chemotherapy and Radiation Therapy)
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