{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T23:40:47Z","timestamp":1773877247892,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T00:00:00Z","timestamp":1646265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002794","name":"Cancerfonden","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002794","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Reports"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>We wanted to evaluate if health care for multiple myeloma (MM) patients is equal in different regions of Sweden.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To study differences in survival for MM depending on health care region and early use of modern treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>Data from the Swedish Myeloma Register from patients diagnosed between 2008 and 2017 was used. Cohorts were defined by the six healthcare regions (labeled A\u2013F) in Sweden and modern initial treatment was defined as including certain drug combinations. To adjust for time to treatment bias, survival analyses were performed also for patients alive 6\u00a0months after diagnosis. In all treated MM patients (<jats:italic>n<\/jats:italic>\u00a0=\u00a05326), we observed a superior overall survival (OS) for region A compared to all other regions (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.01 for all respectively). After adjusting for time to treatment there was also a superior survival in the region with highest use of modern initial treatment (region A) compared to the regions defined in the study as having intermediate and low use (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.01 for both). In patients receiving autologous stem cell transplantation (ASCT) a superior survival was observed for region A compared to all regions besides region B. Similar results were seen when adjusting for a time to treatment bias. In patients not receiving ASCT, 75\u00a0years or older and adjusted for time to treatment bias, a difference was noted only between region A and E (log rank <jats:italic>p<\/jats:italic>\u00a0=\u00a0.04, HR 1.2, CI 1.00\u20131.44, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.06). In multivariate analyses including age, international staging system stage and time period of diagnosis, differences in survival remained for patients receiving ASCT between region A versus C, D, E and F (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.01, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.01, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.01, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We observed a superior survival in region A for patients receiving ASCT. Explanations may be higher usage of modern initial treatment or regional residual confounding. For patients not receiving ASCT, 75\u00a0years or older, differences in survival could be adjusted for.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cnr2.1614","type":"journal-article","created":{"date-parts":[[2022,3,4]],"date-time":"2022-03-04T06:12:38Z","timestamp":1646374358000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Regional differences in treatment and outcome for myeloma patients in Sweden: A population based Swedish myeloma register study"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4533-2335","authenticated-orcid":false,"given":"G\u00f6ran","family":"W\u00e5linder","sequence":"first","affiliation":[{"name":"Department of Medicine Huddinge Karolinska Institute  Solna Sweden"},{"name":"Department of Hematology Karolinska University Hospital Huddinge  Huddinge 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\u00d6rebro University Hospital  \u00d6rebro Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristina","family":"Carlson","sequence":"additional","affiliation":[{"name":"Department of Hematology Uppsala University Hospital  Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorota","family":"Knut\u2010Bojanowska","sequence":"additional","affiliation":[{"name":"Department of Haematology Uddevalla Hospital  Uddevalla Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ljupco","family":"Veskovski","sequence":"additional","affiliation":[{"name":"Department of Hematology S\u00f6dra \u00c4lvsborgs Hospital  Bor\u00e5s Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Birgitta","family":"Lauri","sequence":"additional","affiliation":[{"name":"Department of Hematology Sundeby Hospital  Lule\u00e5 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