The most common MDE before or after MM diagnosis was anemia ( 17.9 % and 25.7 %, respectively ). The incidence of MDEs increased over time ( p < 0.001 ), particularly for hypercalcemia ( increased from < 0.2 % in 1991 to 13.2 % in 2006-2010 ) and bone fractures ( increased from 6.6 % to 19.2 %, respectively ). |
There were significant differences in all complications at and following diagnosis according to patients ’ race ( p < 0.02 ), with a high incidence among African- Americans for all MDEs except bone fractures , which were highest among whites . These results suggest “ that better MM therapeutics and supportive care lead to less organ damage and possibly |
more use of dialysis because of longer survival and a willingness to extend supportive care to more patients ,” the authors wrote .
Cost of care increased significantly by year of diagnosis , despite adjustment for inflation . Drug claims during the first six months after diagnosis increased sharply , from a median of $ 230 between 1991 and 1995 to $ 3,630 between
|
2006 and 2010 ( ranges not reported ; p < 0.001 ), and total claims increased from $ 5,110 to $ 27,800 , respectively ( p < 0.001 ).
“ There were significant differences in the cost of care by patient race ,” the researchers noted .
During the first six months after an MM diagnosis , median drug claims were highest among African-Americans ($ 1,300 ) and
|
Table 2 . Selected Adverse Reactions ( ≥ 10 %) Following Treatment with | ||
KYMRIAH ( N = 68 ) | ||
Adverse Reaction |
All Grades
(%)
|
Grades 3 or Higher
(%)
|
Immune system disorders Cytokine release syndrome |
79 |
49 |
c Hypogammaglobulinemia |
43 |
7 |
Infections and infestations Infections-pathogen unspecified |
41 |
16 |
Viral infectious disorders |
26 |
18 |
Bacterial infectious disorders |
19 |
13 |
Fungal infectious disorders |
13 |
7 |
Investigations International normalized ratio increased |
13 |
0 |
Metabolism and nutrition disorders Decreased appetite |
37 |
15 |
Fluid overload |
10 |
7 |
Musculoskeletal and connective tissue disorders
Pain in extremity
|
16 |
1 |
Myalgia |
15 |
0 |
Arthralgia |
12 |
1 |
Back pain |
10 |
3 |
Nervous system disorders d
Headache
|
37 |
3 |
e Encephalopathy |
34 |
10 |
Psychiatric disorders Delirium |
21 |
4 |
Anxiety |
13 |
3 |
Renal and urinary disorders Acute kidney injury |
22 |
13 |
Respiratory , thoracic and mediastinal disorders
Hypoxia
|
24 |
18 |
Cough |
19 |
0 |
Pulmonary edema |
16 |
10 |
Tachypnea |
12 |
6 |
Pleural effusion |
10 |
4 |
Nasal congestion |
10 |
0 |
Vascular disorders Hypotension |
31 |
22 |
Hypertension |
19 |
6 |
a Tachycardia includes tachycardia and sinus tachycardia . | ||
b Abdominal pain includes abdominal pain , abdominal pain upper , gastrointestinal | ||
pain , abdominal pain lower . | ||
c
Hypogammaglobulinemia includes hypogammaglobulinemia , immunoglobulins
| ||
decreased , blood immunoglobulin G decreased , blood immunoglobulin A | ||
decreased , blood immunoglobulin M decreased , hypogammaglobulinemia . | ||
d Headache includes headache and migraine . | ||
e Encephalopathy includes encephalopathy , cognitive disorder , confusional state , | ||
depressed level of consciousness , disturbance in attention , lethargy , mental status | ||
changes , posterior reversible encephalopathy syndrome , somnolence , and | ||
automatism . | ||
f
Delirium includes delirium , agitation , hallucination , hallucination visual , irritability
| ||
, restlessness . | ||
g Acute kidney injury includes acute kidney injury , anuria , azotemia , renal failure , | ||
renal tubular dysfunction , renal tubular necrosis . | ||
Additional important adverse reactions that did not meet the threshold criteria | ||
for inclusion in Table 2 were : | ||
Blood and lymphatic system disorders : disseminated intravascular coagulation | ||
( 9 %), histiocytosis lymphocytic hemophagocytosis ( 7 %), coagulopathy | ||
( 6 %), Grade 3 and Grade 4 hypofibrinogenemia with Grade 3 and 4 CRS | ||
( 16 %) | ||
Cardiac Disorders : cardiac arrest ( 4 %), cardiac failure ( 7 %) | ||
Gastrointestinal disorders : abdominal compartment syndrome ( 1 %) | ||
General disorders and administration site conditions : multiple organ dysfunction | ||
syndrome ( 3 %) | ||
Immune system disorders : graft versus host disease ( 1 %) | ||
Investigations : blood creatinine increased ( 7 %), activated partial thromboplastin | ||
time prolonged ( 6 %) | ||
Nervous System : intracranial hemorrhage ( 1 %), seizure ( 3 %) | ||
Respiratory , thoracic , and mediastinal disorders : respiratory distress ( 6 %), | ||
respiratory failure ( 6 %), acute respiratory distress syndrome ( 4 %) |