MULTIPLE-MYELOMA - PRESENTING FEATURES AND SURVIVAL ACCORDING TO HOSPITAL REFERRAL

Two-hundred and 31 patients with a newly diagnosed multiple myeloma fi rst seen and admitted to 17 hospitals located in the North-East of Ita ly between 1987 and 1992, were registered for a prospective study on t he course of the disease. Median age was 68 years (range 41-90). Fifty -one per cent were in stage I, 9% in stage II and 40% in stage III. Th e presenting features and the survival of the 61 (26%) patients who we re first admitted to a division of Hematology of a University Hospital (group HEM) were compared with those of the 170 (74%) patients who we re referred to 16 divisions of Internal Medicine at General and County Hospitals (group INT). In the latter group, the patients were older ( p = 0.002),had a poorer performance status (p = 0.0001), a higher freq uency of renal failure (p = 0.006) and anemia (p = 0.02) and higher be ta 2 microglobulin levels (p = 0.01). Median survival of group HEM pat ients did not differ significantly from group INT patients, if all sta ges were considered, but stage II and III patients of group INT had a significantly shorter median survival than advanced stage patients of group HEM (12 vs. 35 months, p = 0.01). If those older than 65 years o r with unfavourable prognostic factors at presentation were excluded, prolonged survival of group INT patients was observed and the curves o f the two groups did not differ significantly anymore. These results s how that the patients recruited by a specialized centre may represent a selected population with better prognostic factors and younger age a nd this may affect analysis of clinical trials. Participation of minor centres in clinical trials may considerably contribute in improving i nterpretation of results of therapy in myeloma and be more representat ive of the entire population.