High prevalence of peripheral neuropathy in multiple myeloma patients and the impact of vitamin D levels, a cross-sectional study

Purpose: Peripheral neuropathy (PN) is common in patients with multiple myeloma (MM). We hypothesized that the relationship between hypovitaminosis D and PN described in diabetes mellitus patients may also be present in MM patients. Methods: To study this potential association, we assessed the incidence of hypovitaminosis D (vitamin D < 75 nmol/L [= 30 ng/mL]) in smouldering and active MM patients in two Dutch hospitals. Furthermore, a validated questionnaire was used to distinguish different PN grades. Results: Of the 120 patients included between January 2017 and August 2018, 84% had an inadequate vitamin D level (median vitamin D level 49.5 nmol/L [IQR 34–65 nmol/L]; mean age: 68 years [SD ± 7.7]; males: 58%). PN was reported by 69% of patients (n = 83); however, of these 83 patients, PN was not documented in the medical records of 52%. An association was found between lower vitamin D levels and higher incidence of PN in the total population (P = 0.035), and in the active MM patients (P = 0.016). Conclusion: This multi-centre cohort study showed that PN and hypovitaminosis D are common in MM patients, and addressing low vitamin D levels in the treatment of MM patients might be beneficial in reducing the risk of PN. More attention for PN is warranted, as PN is underreported by clinicians. Further research is needed to fully understand the implications of vitamin D in the development of PN in patients with MM. Clinical trial registration: Netherland Trial Register NL5835, date of registration July 28, 2016

Stress en toxiciteit ; de effecten van gecombineerde blootstelling aan geluid en ozon

Onderzoeksresultaten worden representeerd van de cumulatieve blootstelling aan geluid (subchronisch) en ozon (acuut) bij ratten. Geluid-blootstelling vond plaats gedurende 1 tot 3 weken bij een intensiteit van 85 tot 105 dB witte ruis middels een gerandomiseerd blootstellingsregime van 180 tot 540 minuten per dag. Blootstelling aan geluid induceerde verhogingen van de basale spiegels van corticosteron, prolactine en noradrenaline waarbij factoren als geluidsintensiteit en blootstellingsregime een belangrijke invloed hadden. Daarnaast resulteerde geluid-blootstelling in een significant veranderde reactie op een nieuwe acute stressor hetgeen aangeeft dat de fysiologische status van het dier duidelijk is veranderd. In vergelijking met blootstelling aan alleen ozon, leidde de cumulatieve blootstelling aan geluid en ozon tot significante veranderingen in de toxiciteit van ozon. Zowel met betrekking tot biochemische als immunologische variabelen, werden aanwijzingen gevonden voor een interactie tussen geluid en ozon. Echter, deze effecten waren in kwantitatief opzicht bescheiden van omvang en leidden niet tot een algemene versterking van de toxische effecten na acute ozon blootstelling. Verder onderzoek zal moeten uitwijzen wat de consequenties van de gevonden interacties zijn voor langdurig of herhaalde ozon blootstelling. In het algemeen kan worden gesteld, dat de huidige studies geen aanwijzingen hebben opgeleverd die erop duiden dat cumulatieve blootstelling aan heterogene contaminanten kan leiden tot een versterking of verandering van gezondheidseffecten.The effects of combined exposure to subchronic noise and acute ozone exposure have been investigated in rats. Noise exposure ranged from 1 to 3 weeks at intensities of 85 to 105 dB for 180 to 540 min per day in random profiles. Noise induced significant elevations in the basal levels of corticosterone, prolactin, and noradrenaline in which both intensity and the exposure profiles were important determinants. In addition, noise exposure also induced marked changes in the physiological response to a novel acute stressor indicating a changed physiological status. Compared to ozone only, the combined exposure to noise and ozone resulted in significant changes in the toxicity response. Both biochemically and immunologically indications were found for an interaction between these two factors. However, quantitatively the changes were relatively modest and the overall severity of the response to acute ozone exposure was not enhanced. Generally, the present studies did not indicate that combined exposure to heterogeneous contaminants would result in enhanced or unexpected toxicity effects and the general 'rule of assuming additivity' for combined exposure may be valid also for heterogeneous contaminants.DGM/L

The role of initial clinical presentation, comorbidity and treatment in multiple myeloma patients on survival:A detailed population-based cohort study

Purpose This prospective, observational population-based cohort study was performed to determine overall survival (OS) in multiple myeloma (MM) patients in Friesland, the Netherlands, in the era of novel agents and to analyse the influence of first-line treatment, MM-related end-organ damage and comorbidities at initial presentation on OS. Methods Detailed clinical information was obtained from the population-based registry 'HemoBase' during the period January 2005 to January 2013, with a follow-up to January 2014. Results Overall, the symptomatic MM patients (n = 225) had a median OS of 40 months. In the age categories <65, 65-75 and >= 75 years, 99, 94 and 87% of the patients received treatment, with a median OS of 92, 42 and 31 months, respectively. OS for patients with or without treatment was 43 and 3 months, respectively. In multivariable analysis, risk factors for worse OS were increasing age (<65: reference; 65-75: HRadj. = 2.2 (95% CI 1.3-3.7) and >= 75: HRadj. = 2.8 (95% CI 1.7-4.8); P <0.001), not receiving initial treatment (HRadj. = 4.0 (95% CI 2.1-7.7); P <0.001), hypercalcaemia (P <0.001, HRadj. = 1.7 (95% CI 1.2-2.6), P = 0.006) and impaired renal function (HRadj. = 2.6 (95% CI 1.7-4.0); P <0.001). Conclusions Increasing age, not receiving initial treatment, hypercalcaemia and impaired renal function at initial presentation were independent risk factors for worse OS. Comorbidity according to Charlson comorbidity index score was not an independent variable predicting OS

Bridging the gap between the randomised clinical trial world and the real world by combination of population-based registry and electronic health record data: A case study in haemato-oncology

Randomised clinical trials (RCTs) are considered the basis of evidence-based medicine. It is recognised more and more that application of RCT results in daily practice of clinical decision-making is limited because the RCT world does not correspond with the clinical real world. Recent strategies aiming at substitution of RCT databases by improved population-based registries (PBRs) or by improved electronic health record (EHR) systems to provide significant data for clinical science are discussed. A novel approach exemplified by the HemoBase haemato-oncology project is presented. In this approach, a PBR is combined with an advanced EHR, providing high-quality data for observational studies and support of best practice development. This PBR + EHR approach opens a perspective on randomised registry trials