Abstract 3302: Cardiovascular and thromboembolic diseases as a cause of death in multiple myeloma patients: A population based study
Authors: Elfaituri Muhammed Khaled , Morsy Sara , El-Qushayri Amr Ehab , Faraj Hazem Abdelkarem , Tran Minh-Duc Nguyen , Ebied Amr , Ebied Amr , Huy Nguyen Tien 
Published: August 2019

Abstract
Introduction: Multiple myelomas (MM) is characterized by the neoplastic proliferation of plasma cells producing a monoclonal immunoglobulin. Despite the remarkable improvement in survival rates with different treatment approaches; multiple myeloma patients are at higher risk of cardiovascular and thromboembolic events. Therefore, we aim to identify high-risk patients for cardiovascular mortality and provoke awareness among physicians for choosing appropriate therapy for better survival rates in those patients.
Methods Surveillance, Epidemiology, and End Results Program database used for this work. Kaplan Meier survival curves were constructed to compare the survival probabilities. Furthermore, Cox regression analysis was conducted to detect the most important factors determining the survival time. The significant variables were used to construct nomogram and its fit was assessed using c-index.
Results The cohort included 55991 multiple myeloma patients with 4510 deaths by cardiovascular and thromboembolic events. There was a significant difference in age between both groups (P-value &lt; 0.001). There was a significant difference between both groups regarding the treatment choices, type of radiation, race and marital status. SEER database identified four diseases as a cause of death in multiple myeloma: Aortic aneurysm and dissection (n = 39), atherosclerosis (n = 88), cerebrovascular diseases (n = 1861) and diseases of the heart (n = 3799). Kaplan Meier survival curves revealed a significant difference in the survival probability between the multiple myeloma grades (P &lt; 0.001). We found that hypertension with multiple myeloma has the best median survival (median =1, 95% CI (0.133,1) and the worst survival was in patients diagnosed with an aortic aneurysm and dissection (median =0.09, 95% CI (0.03,0.25). Cardiac causes of death had less survival than other reported causes of death. The log-rank test found significantly different median survival between different cardiac causes (p&lt;0.0001). Cox proportional hazard ratio regression revealed that gender [Male (HR = 1.39, SE = 0.03, P-value = 0.005], age (HR = 1.07, SE = 0.0015, P-value = 0.005), marital status (HR = 0.81, SE = 0.064, P-value = 0.0014), grade and surgery were significant risk factors for death with thromboembolic and cardiovascular diseases. These variables were used in nomogram. The c-index of the nomogram was [0.72, 95%CI (0.71 - 0.73)]. The prediction error (OOB) of the tree was 0.10. We found that random forest model had less survival over time than cox regression.
Conclusion: The mortality from by cardiovascular and thromboembolic events in MM was associated with several factors. Our considerations and further investigations of them is needful. It may aid in identifying the patients who can get the uppermost benefits of cardiovascular and thromboembolic prophylaxis and treatment measures.
Citation Format: Muhammed Khaled Elfaituri, Sara Morsy, Amr Ehab El-Qushayri, Hazem Abdelkarem Faraj, Minh-Duc Nguyen Tran, Amr Ebied, Amr Ebied, Nguyen Tien Huy. Cardiovascular and thromboembolic diseases as a cause of death in multiple myeloma patients: A population based study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3302.