Regional differences in treatment and outcome for myeloma patients in Sweden: A population based Swedish myeloma register study

Göran Wålinder, Anna Genell, Gunnar Juliusson, Ronald Svensson, Antonio Izarra Santamaria, Jacob Crafoord, Kristina Carlson, Dorota Knut-Bojanowska, Ljupco Veskovski, Birgitta Lauri, Johan Lund, Ingemar Turesson, Markus Hansson, Cecilie Hveding Blimark, Hareth Nahi

Research output: Contribution to journalArticlepeer-review


Background: We wanted to evaluate if health care for multiple myeloma (MM) patients is equal in different regions of Sweden. Aim: To study differences in survival for MM depending on health care region and early use of modern treatment. Methods and results: Data from the Swedish Myeloma Register from patients diagnosed between 2008 and 2017 was used. Cohorts were defined by the six healthcare regions (labeled A–F) in Sweden and modern initial treatment was defined as including certain drug combinations. To adjust for time to treatment bias, survival analyses were performed also for patients alive 6 months after diagnosis. In all treated MM patients (n = 5326), we observed a superior overall survival (OS) for region A compared to all other regions (p <.01 for all respectively). After adjusting for time to treatment there was also a superior survival in the region with highest use of modern initial treatment (region A) compared to the regions defined in the study as having intermediate and low use (p <.01 for both). In patients receiving autologous stem cell transplantation (ASCT) a superior survival was observed for region A compared to all regions besides region B. Similar results were seen when adjusting for a time to treatment bias. In patients not receiving ASCT, 75 years or older and adjusted for time to treatment bias, a difference was noted only between region A and E (log rank p =.04, HR 1.2, CI 1.00–1.44, p =.06). In multivariate analyses including age, international staging system stage and time period of diagnosis, differences in survival remained for patients receiving ASCT between region A versus C, D, E and F (p =.01, p <.01, p <.01, p =.03). Conclusion: We observed a superior survival in region A for patients receiving ASCT. Explanations may be higher usage of modern initial treatment or regional residual confounding. For patients not receiving ASCT, 75 years or older, differences in survival could be adjusted for.

Original languageEnglish
Article numbere1614
JournalCancer Reports
Issue number11
Early online date2022
Publication statusPublished - 2022 Nov

Subject classification (UKÄ)

  • Cancer and Oncology

Free keywords

  • cancer care
  • epidemiology
  • multiple myeloma
  • treatment outcome


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