Study On The Causation, Prognostic Factors And Quality Of Life Of Multiple Myeloma

Objective: To investigate potential risk factors (life style, environment andfamily history) of multiple myeloma (MM), to explore prognostic factors ofMM, and to evaluate influence factors on MM patients’ quality of life (QOL).Methods: The investigation was a hospital-based case-control study consistingof MM cases and gender-age-matched controls at5hospitals in Xi’an, Chinafrom August,2010to February,2012. A questionnaire was used to obtaininformation on demographics, family history, and the frequency of food itemsconsumed, and QOL-C30was used to evaluate the QOL of MM patients.Anti-EBV, anti-HBc, HBsAg and anti-HCV were detected with enzyme-linkedimmunosorbent assay. Clinical and laboratory parameters were gathered whenpatients were diagnosed as MM in hospital. Risk factors and prognostic factorsof MM were analyzed using conditional and multiple logistic regression models.The factors which influenced the quality of life were calculated using SPSS17.0software. Statistical significance was based on two-tailed tests evaluated at the0.05level of significance.Results: A total of440participants, including220eligible MM cases and220controls were interviewed. The mean age at interview of the cases was57.43years±10.98. Obesity (OR=2.00,95%CI:1.39-2.90), family history of any cancers in first degree relatives(OR=4.03,95%CI:2.50-6.52), intake of pickledvegetables (OR=2.03,95%CI:1.41-2.93) and experienced negative life event(OR=2.16，95%CI:1.44-3.24) were associated with increased risk of MM.Consumptions of garlic (OR=0.60,95%CI:0.43-0.85), soy foods (OR=0.52,95%CI:0.36-0.75) and green tea (OR=0.38,95%CI:0.27-0.53) were associatedwith reduced risk of MM. A significant interaction was detected between shallotand garlic, and soy food (OR=0.59,95%CI:0.40-0.87). There were nosignificant correlations between MM and HBV, HCV or EBV infection.A total of22MM cases who died within1year after diagnosis were as the poorprognosis group, and66patients who survived more than1year were as thecontrol group. Univariate analysis identified6poor prognostic factors: age≥60years (OR=2.35,95%CI:1.23-4.46), their own expense proportion≥30%(OR=2.05,95%CI:1.10-3.81), financial difficulty (OR=1.56,95%CI=1.01-2.38), high level of serum β2-MG (OR=6.25，95%CI：1.19-33.33),ratio of serum free light chain <1.35or>2.65(OR=2.70,95%CI:1.28-5.56) andstage II+III of ISS (OR=1.54,95%CI=1.04-2.27). Multivariate analysis showedthat the older (age≥60)(OR=3.55,95%CI:1.63-7.71), high level of serumβ2-MG (OR=3.85,95%CI:1.08-14.29) and abnormal ratio of serum free lightchain (OR=2.50,95%CI:1.02-6.11) were independent poor prognostic factors.The total score of QOL in MM patients was (49.0±21.7). The QOL of MMpatients had significantly lower score than normal people or the other tumorpatients. The scores of fatigue, nausea, vomiting, pain, difficulty breathing,sleep disturbance, decreased appetite, constipation, financial difficulty and othersymptoms were significantly higher than the norm (P<0.05or P<0.01). MMpatients’ symptoms and functions were very obviously affected. The older(especially age>70), the higher proportion of medical costs by own expense and poor were the main factors of quality of life (P<0.05). MM patients had worseclinical staging and worse quality of life. Anemia, high level of serum calciumand globulin significantly reduced quality of life (P <0.05).Conclusions: The risk for MM occurrence in Northwest China was increasedwith obesity, a diet characterized by a low consumption of garlic, green tea andsoy foods, and high consumption of pickled vegetable, family history of cancerand experienced negative life event.The older (age>60), abnormal ratio of serum free light chain and high level ofserum β2-MG were correlated to poor prognosis.The quality of life of MM patients was significantly lower than normal, andlower than the other tumors and those with chronic diseases. Economic factorsaffected the elderly and low reimbursement patients’ QOL. The assessment oftreatment should pay more attention to the improvement of hemoglobin, serumcalcium and globulin, which could improve the symptoms of fatigue and painwhich seriously impact on patients’ QOL.