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Is Hypercalcemia Linked to Poor Survival in Newly Diagnosed Multiple Myeloma?

By: Justine Landin, PhD
Posted: Friday, January 8, 2021

 Hypercalcemia may be a poor prognostic factor for patients recently diagnosed with multiple myeloma, according to researchers from Beijing Jishuitan Hospital, China. Results from this study indicated that early mortality rates were nearly doubled in patients with hypercalcemia of malignancy. The study authors suggested that excessive calcium levels were caused by multiple factors, including humoral immunity levels and local bone destruction. This retrospective, single-center analysis was published in Cancer Medicine.

“The symptoms and serum calcium level of all patients with hypercalcemia improved quickly within the first week after bisphosphonate application and chemotherapy. However, the use of these drugs did not alter the poor prognosis of patients with hypercalcemia,” stated Qiuqing Xiang, MD, and colleagues.

Of the 357 patients who were newly diagnosed with symptomatic multiple myeloma and in good clinical condition, 16.8% presented with hypercalcemia. Patients were classified depending on the original or revised International Staging System (ISS or R-ISS). All participants received four cycles of bortezomib- or thalidomide-based induction regimens. Patients with partial responses received stem cell mobilization followed by high‐dose chemotherapy and lenalidomide maintenance. Blood samples were collected for analysis of cytogenic, clinical, and bone mineral metabolism markers.

At a median follow-up of 24 months, patients with hypercalcemia exhibited significantly inferior survival compared with nonhypercalcemic patients (36.3 months vs. 56.8 months, P = .019). Additionally, hypercalcemia was associated with a significantly higher early mortality rate (18.33%) compared with no hypercalcemia (8.41%, P = .048). Advanced ISS and R-ISS stages were associated with hypercalcemia, and the proportion of mild, moderate, and severe hypercalcemia was associated with the proportion of renal failure (23.8%, 60.7%, and 81.8%, respectively). A multivariate analysis indicated that serum parathyroid hormone (P = .006), creatinine (P = .001), uric acid (P = .001), and hemoglobin (P = .005) levels were the most significant factors of hypercalcemia.

Disclosure: The study authors reported no conflicts of interest.

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