Khan, Muhammad Azeem

Abstract Therapeutic options for Waldenström macroglobulinemia (WM) have expanded but improvements in overall-survival (OS) are difficult to interpret due to competing non–WM mortality. We conducted a large single-center retrospective study of 1,020 patients with WM to evaluate survival trends. Patients were stratified by era of active WM diagnosis using a two-era model (1996–2005 and post-2005) and a four-era model (pre-2001, 2001–2007, 2008–2013, and post-2013). OS did not differ significantly across eras in the overall cohort (p = 0.64 and p = 0.86 for the two- and four-era models). However, among patients aged < 65 years at the time of active WM diagnosis in the 2-era model, OS improved in the post-2006 era (median 18.8 vs 14.1 years, p = 0.018). Cause-specific-survival (CSS) improved across all eras, increasing from 15.6 years in 1996–2005 to 18.9 years post-2006 (p < 0.0001), and from 13.7 years pre-2001 to not reached in later periods in the four-era model (p < 0.0001). Competing-risk-analysis (CRA) demonstrated a reduction in WM-related mortality over time (p < 0.001). However, excess mortality persisted, with a standardized mortality ratio (SMR) of 2.79 (p < 0.001) among patients < 65 years compared with a matched U.S. population. Our findings highlight improvements in WM-specific survival, while gains in OS are observed in younger patients.

Abstract Background:Erdheim-Chester Disease (ECD) is a rare, incurable histiocytic neoplasm. Since its recognition in 1930, our understanding of ECD's pathophysiology has evolved. The identification of its clonal nature after 2015 established ECD as a cancer, prompting increased disease awareness and treatment advances. Targeted therapies show promising responses, but changes in ECD mortality over time have not been extensively documented. Methods:A multi-institutional retrospective cohort study analyzed adults with ECD consecutively seen at Mayo Clinic MN, AZ, and FL and the University of Alabama at Birmingham between 2007 and 2024. Clinical and prognostic data were abstracted. Overall survival was estimated using the Kaplan-Meier method and compared to expected survival using U.S. Census data, based on age at diagnosis (by calendar year), date of diagnosis, and sex. Standardized mortality ratios (SMRs) were calculated by dividing the number of observed deaths in the study population by the expected number of deaths using U.S. population data. Risk of death was compared by date of diagnosis (pre- and post-2015) using Cox proportional hazards analysis. Statistical analysis was performed with R software. Results:A total of 159 ECD patients were included (median age 58 years [range 19-82], 65% male). Forty-nine patients were diagnosed between 1990-2014 and 110 between 2015-2024. Median follow-up for the entire cohort was 4.0 years (95% CI: 3.2-4.4). Median follow-up for those diagnosed between 1990-2014 was 10.4 years (CI: 3.2-16.8), compared to 3.5 years (CI: 3.0-4.2) for those diagnosed between 2015-2024. The 5-year overall survival rate was 80% (95% CI: 72-88). Patients with ECD had an increase in mortality over expected, with 28 deaths compared to an expected 11.2, an SMR of 2.5 (95% CI: 1.7-3.6, p&lt;0.001). Of 17 patients with an identified cause of death, death was attributable to ECD in 11 (65%), secondary malignancy in 1 (7%), and unrelated causes in 5 (29%). Cause of death was unknown in 11 patients. Among deaths, 11 (39%) were treated with targeted therapy, 8 (29%) with chemotherapy, and 1 (4%) received both. One patient (4%) received steroids, 1 received immunomodulator and targeted therapy (4%), and 6 (21%) received no disease-directed therapy. Of the patients whose death was related to ECD, 10 (91%) had multisystem disease. For 49 patients diagnosed pre-2015, 14 deaths occurred during the follow-up, significantly higher than the expected 5.2 deaths based on U.S. population data (SMR of 2.7 [95% CI: 1.5-4.4, p=0.001]). Among those diagnosed between 2015 and 2024, 14 deaths occurred, compared to expected 6.1 (SMR of 2.3 [95% CI: 1.3-3.8, p=0.006]). In an age- and sex-adjusted Cox proportional hazards model, diagnosis after 2015 vs. diagnosis prior to 2015 yielded a hazard ratio of 0.59 (95% CI: 0.27-1.31, p=0.19). Conclusion:The mortality rate of ECD patients remains higher than the general population, despite advancements in disease recognition and development of targeted therapies. While our data suggest a possible trend toward improved survival among patients diagnosed after 2015, we did not find statistically significant evidence of decreased mortality compared to those diagnosed prior to 2015. Larger cohorts with longer follow-up periods are needed to draw definitive conclusions regarding mortality.

Abstract Introduction: Monoclonal gammopathy (MG) is a spectrum of conditions including monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM). MM is the second most common hematologic malignancy. Despite advances in the treatment of MM it remains an incurable disease that accounts for > 80 000 deaths annually worldwide. Many etiologies for myelomagenesis have been postulated. One theory suggests that chronic antigen stimulation from rheumatologic conditions can increase the risk of MG. Numerous studies have reported an increased risk of MG and other lymphoproliferative disorders in patients with systemic lupus erythematosus (SLE) and Sjogren's syndrome (SS). However, the association between rheumatoid arthritis (RA) and MG is controversial as conflicting results have been reported. Case control studies have described an increased risk of RA but this finding was not corroborated in a subsequent meta-analysis. We used the national inpatient sample (NIS) database to explore the association of RA with MGUS and MM. Methods: The NIS is a validated database derived from discharge billing information which provides a sample of all non-federal hospital discharges in the Unites States. We identified adult patients with discharge diagnosis codes for MGUS (ICD-9 273.1), MM (ICD-9 203.0), RA (ICD-9 714.0), SLE (ICD-9 710.0) and SS (ICD-9 710.2) from 2014. Demographic data such as age, sex and race were also obtained. Multiple logistic regressions were used to analyze data for association of RA with MGUS and MM after adjusting for age, gender, race and other rheumatic diseases. Statistical analysis was performed with STATA 14. Results: A total of 7,071,762 discharges were analyzed. There were 20,066 hospitalized adults with discharge diagnosis codes for MM and 6,433 patients with a discharge diagnosis of MGUS. The prevalence of RA in patients with MGUS is 5.1% (p<0.001) and the prevalence of RA in patients with MM is 1.6 % (p=0.92). By logistic regression MGUS was associated with RA (OR 2.04, CI 1.80 - 2.32, p<0.0001) when adjusted for age, gender, race, SLE and SS. However, logistic regression did not show a significant association between MM and RA when adjusted for the same variables (OR 1.05, CI 0.95-1.15, p=0.23). MGUS was significantly associated with SS (OR 4.4, CI 3.29-5.90, p<0.001) and SLE (OR 1.9, CI 1.44-2.43, p<0.001) when adjusted for variables. Discussion: Our review of the NIS database found a significant association between rheumatologic disorders (RA, SLE and SS) and MGUS. These results are in concordance with previous retrospective studies. However, we did not find a significant relationship between RA and MM. There is known to be a high prevalence of MGUS in the general population, the clinical significance of which is being debated. The association between RA and MGUS that our study found may be due to a selection bias as patients with rheumatic conditions such as RA are tested more frequently for MGUS than the general population. Disclosures No relevant conflicts of interest to declare.