Annals of Hematology

, Volume 98, Issue 4, pp 941–949 | Cite as

Survival differences in multiple myeloma in Latin America and Asia: a comparison involving 3664 patients from regional registries

  • Vania T. M. HungriaEmail author
  • Jae Hoon Lee
  • Angelo Maiolino
  • Edvan de Queiroz Crusoe
  • Gracia Martinez
  • Rosane Bittencourt
  • Gislaine Oliveira Duarte
  • Dorotea Beatriz Fantl
  • Juan Ramon Navarro
  • Guillermo Conte
  • David Gomez-Almaguer
  • Guillermo J. Ruiz-Argüelles
  • Kihyun Kim
  • Kazuyuki Shimizu
  • Wenming Chen
  • Shang-YI Huang
  • Wee-Joo Chng
  • Chor Sang Chim
  • Weerasak Nawarawong
  • Brian Durie
Original Article


In previous observational studies, we have separately characterized patients with multiple myeloma (MM) both from Latin America (LA) and from Asia. Here, we analyze these two datasets jointly, in order to assess the overall survival (OS) in these two world regions. Data were available from 3664 patients (1968 from LA and 1696 from Asia); all of whom diagnosed between 1998 and 2007. Approximately, 26% of patients in both world regions underwent transplantation. OS (from diagnosis of MM) was explored with Kaplan–Meier analyses and Cox proportional hazards models. Patients from LA were significantly younger and had hypercalcemia more often than Asian patients, who in turn had higher proportions of anemia and International Staging System (ISS) stage III disease. The median OS was 56 months in LA, and 47 months in Asia (hazard ratio [HR] = 0.83; 95% confidence interval [CI], 0.76 to 0.91; P < 0.001). In multivariable analysis, age, ISS stage III, anemia, hypercalcemia, and world region remained significantly associated with OS (P < 0.001 for all covariates). These results were largely driven by patients not undergoing transplantation, as no difference in OS emerged between the two world regions in univariable or multivariable analysis for transplanted patients. Despite adverse prognostic features differentially favoring each region, and adjusting for such differences, we found an OS advantage for patients from LA, in comparison with contemporaneous patients from Asia. Whether this is due to different biological features, differences in access to novel agents (especially thalidomide in earlier periods of the study), unmeasured confounders, or the play of chance, remain unknown.


Multiple myeloma Survival analysis Latin America and Asia 


Compliance with ethical standards

The protocol for each study was approved by the competent local authorities and institutional review boards, and written informed consent was obtained from all patients.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

277_2019_3602_MOESM1_ESM.docx (53 kb)
ESM 1 (DOCX 52 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Vania T. M. Hungria
    • 1
    Email author
  • Jae Hoon Lee
    • 2
  • Angelo Maiolino
    • 3
  • Edvan de Queiroz Crusoe
    • 4
  • Gracia Martinez
    • 5
  • Rosane Bittencourt
    • 6
  • Gislaine Oliveira Duarte
    • 7
  • Dorotea Beatriz Fantl
    • 8
  • Juan Ramon Navarro
    • 9
  • Guillermo Conte
    • 10
  • David Gomez-Almaguer
    • 11
  • Guillermo J. Ruiz-Argüelles
    • 12
  • Kihyun Kim
    • 13
  • Kazuyuki Shimizu
    • 14
  • Wenming Chen
    • 15
  • Shang-YI Huang
    • 16
  • Wee-Joo Chng
    • 17
  • Chor Sang Chim
    • 18
  • Weerasak Nawarawong
    • 19
  • Brian Durie
    • 20
  1. 1.Santa Casa Medical SchoolSao PauloBrazil
  2. 2.Hematology-Oncology, Division of Hematology/OncologyGachon University Gil Medical CenterIncheonRepublic of South Korea
  3. 3.Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio de JaneiroRio de JaneiroBrazil
  4. 4.Hospital General Roberto SantosSalvadorBrazil
  5. 5.Universidade de São PauloSao PauloBrazil
  6. 6.Hospital de Clínicas de Porto AlegrePorto AlegreBrazil
  7. 7.Centro de Hematologia e HemoterapiaUniversidade de CampinasSao PauloBrazil
  8. 8.Hospital Italiano de Buenos AiresBuenos AiresArgentina
  9. 9.Hospital Edgardo RebagliatiLimaPeru
  10. 10.Universidad de ChileSantiagoChile
  11. 11.Servicio de HematologíaUniversidad Autonoma de Nuevo Leon, Hospital Universitario “Dr. José Eleuterio Gonzalez”MonterreyMexico
  12. 12.Clinica Ruiz De Puebla, Centro de HematologiaPueblaMexico
  13. 13.Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  14. 14.National Organization Higashi Nagoya National HospitalNagoyaJapan
  15. 15.Beijing Chaoyang HospitalBeijingChina
  16. 16.National Taiwan University HospitalTaipeiTaiwan
  17. 17.National University Cancer InstituteSingaporeSingapore
  18. 18.Queen Mary Hospital, University of Hong Kong, ChinaPok Fu LamHong Kong
  19. 19.Chiang Mai UniversityChiang MaiThailand
  20. 20.Cedars-Sinai Medical CenterLos AngelesUSA

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