Large-scale real-life analysis of survival and usage of therapies in multiple myeloma.

Survival in multiple myeloma has improved significantly in recent years, especially in young patients. We reviewed the evolution of the survival of patients with MM in three groups based on age at MM diagnosis over three time periods between 1999 and 2020 at our 12 de Octubre Hospital institution (H12O). Then, to confirm our results, we used data from TriNetx, a global health research platform that includes patients from Europe to US. Finally, we analysed differences in the patterns of treatment between networks across the world. Kaplan‒Meier analysis was used to estimate survival probabilities, and between-group differences were tested using the log-rank test and hazard ratio. For patients from H12O, the median OS was 35.61, 55.59 and 68.67 months for the 1999-2009, 2010-2014 and 2015-2020 cohorts, respectively (p = 0.0001). Among all patients included in the EMEA network, the median OS was 20.32 months versus 34.75 months from 1999-2009 versus 2010-2014. The median OS from the 2010-2014 versus 2015-2020 time cohorts was 34.75 months versus 54.43 months, respectively. In relation to the US cohort, the median OS from before 2010 versus 2010-2014 was not reached in either time cohort and neither when comparing the 2010-2014 versus 2015-2019 time cohorts. Bortezomib is the most commonly used drug in the EMEA cohort, while lenalidomide is the most commonly used drug in the US cohort. This large-scale study based on real-world data confirms the previous finding that MM patients have increased their survival in the last two decades.

Impact of COVID-19 in patients with multiple myeloma based on a global data network.

The COVID-19 pandemic has represented a major cause of morbidity/mortality worldwide, overstressing health systems. Multiple myeloma (MM) patients show an increased risk for infections and they are expected to be particularly vulnerable to SARS-CoV-2 infection. Here we have obtained a comprehensive picture of the impact of COVID-19 in MM patients on a local and a global scale using a federated data research network (TriNetX) that provided access to Electronic Medical Records (EMR) from Health Care Organizations (HCO) all over the world. Through propensity score matched analyses we found that the number of new diagnoses of MM was reduced in 2020 compared to 2019 (RR 0.86, 95%CI 0.76-0.96) and the survival of newly diagnosed MM cases decreased similarly (HR 0.61, 0.38-0.81). MM patients showed higher risk of SARS-CoV-2 infection (RR 2.09, 1.58-2.76) and a higher excess mortality in 2020 (difference in excess mortality 9%, 4.4-13.2) than non-MM patients. By interrogating large EMR datasets from HCO in Europe and globally, we confirmed that MM patients have been more severely impacted by COVID-19 pandemic than non-MM patients. This study highlights the necessity of extending preventive measures worlwide to protect vulnerable patients from SARS-CoV-2 infection by promoting social distancing and an intensive vaccination strategies.

Mapping clinical procedures to the ICD-10-PCS: The German operation and procedure classification system use case.

Mappings among terminologies to ensure homogeneous analysis among different data sources is one of the key challenges of semantic interoperability. Concretely, mappings to the International Classification of Diseases 10th Revision Procedure Classification System (ICD-10-PCS) are especially challenging due to its multiaxial structure and lack of terms used by physicians (many terminologies used in real world data (RWD) are initially intended for reimbursement, not for clinical purposes). In this work, we propose a new theoretical methodology for mapping healthcare data to the ICD-10-PCS by exploiting its multiaxial structure to reduce the search spaces within concepts and leveraging the dependencies between axes for inferring additional relevant information. We tested this methodology with a subset of the German Operation and Procedure Classification System (OPS), aiming to integrate heterogeneous data sources queried for clinical research.

ICD-10-CM extension with ICD-9 diagnosis codes to support integrated access to clinical legacy data.

INTRODUCTION: ICD is currently the most widely used terminology to code diagnosis and procedures. The transition from ICD-9-CM to ICD-10-CM became effective on October 1, 2015 in US and many other countries. Projects that use this codification for research purposes, requires advanced methods to exploit data with both versions of ICD. Although the General Equivalence Mappings (GEMs), provided by the Centers for Medicare and Medicaid Services, might help to overcome these challenges, their direct use as translation mappings is not possible, mostly due to the further specificity of ICD-10-CM concepts. OBJECTIVE: We propose a methodology to generate an extended version of ICD-10-CM with selected ICD-9-CM diagnosis codes. METHODS: The extension was generated using the GEMs relations between concepts of both terminologies and the hierarchical relations of ICD-10-CM. RESULTS: This extended ICD-10-CM, together with modifications to the mapping of ICD-9-CM concepts that were not inserted, allows the generation of an improved translation of legacy data, raising the number of 1-to-1 correspondences by +13.81%. CONCLUSION: The extended ICD-10-CM enables the accurate integration of ICD-9-CM and ICD-10-CM diagnosis data into a single terminology. With such analysis of data possible without having to specify both ICD-9-CM and ICD-10-CM separately for each query.

ICD-10-PCS extension with ICD-9 procedure codes to support integrated access to clinical legacy data.

Since the creation of The International Classification of Diseases (ICD), new versions have been released to keep updated with the current medical knowledge. Migrations of Electronic Health Records (EHR) from ICD-9 to ICD-10-PCS as clinical procedure codification system, has been a significant challenge and involved large resources. In addition, it created new barriers for integrated access to legacy medical procedure data (frequently ICD-9 coded) with current data (frequently ICD-10-PCS coded). This work proposes a solution based on extending ICD-10-PCS with a subgroup of ICD-9-CM concepts to facilitate such integrated access. The General Equivalence Mappings (GEMs) has been used as foundation to set the terminology relations of these inserted concepts in ICD-10-PCS hierarchy, but due to the existence of 1-to-many mappings, advanced rules are required to seamlessly integrate both terminologies. With the generation of rules based on GEMs relationships, 2014 ICD-9 concepts were included within the ICD-10-PCS hierarchy. For the rest of the concepts, a new method is also proposed to increase 1-to-1 mappings. As results, with the suggested approach, the percentage of ICD-9-CM procedure concepts that can be mapped accurately (avoiding mappings to a large number of concepts) rise from 11.56% to 69.01% of ICD-9-Proc, through the extended ICD-10-PCS hierarchy.