Background: Disparities in multiple myeloma (MM) prognosis based on sociodemographic factors may exist. We investigated whether education level at diagnosis influenced Chinese MM patient outcomes.Methods: We performed a multicenter retrospective analysis of data from 773 MM patients across 9 centers in China from 2006 to 2019. Sociodemographic and clinical factors at diagnosis and treatment regimens were recorded, and univariate and multivariate analyses were performed.Results: Overall, 69.2% of patients had low education levels. Patients with low education levels differed from those with high education levels in that they were more likely to be older, and a higher proportion lived in rural areas, were unemployed, had lower annual incomes and lacked insurance. Additionally, compared to patients with high education levels, patients with low education levels had a higher proportion of international staging system (ISS) stage III classification and elevated lactate dehydrogenase (LDH) levels and underwent transplantation less often. Patients with high education levels had a median progression-free survival (PFS) of 67.50 (95% confidence interval (CI): 51.66-83.39) months, which was better than that of patients with low education levels (30.60 months, 95% CI: 27.38-33.82, p<0.001). Similarly, patients with high education levels had a median overall survival (OS) of 122.27 (95% CI: 117.05-127.49) months, which was also better than that of patients with low education levels (58.83 months, 95% CI: 48.87-62.79, p<0.001). In the multivariable analysis, patients with high education levels had lower relapse rates and higher survival rates than did those with low education level in terms of PFS and OS (hazard ratio (HR)=0.50 [95% CI: 0.34-0.72], p<0.001; HR=0.32 [0.19-0.56], p<0.001, respectively).Conclusions: Low education levels may independently predict poor survival in MM patients in China.

IgG4-related disease (IgG4-RD) is an immune-mediated disorder hallmarked with lymphoplasmacytic tissues infiltrated with abundant IgG4-positive plasma cells, which has various clinical features and easily to be misdiagnosed. Here, we described a case with symptoms of body weight loss and multiple lymph node enlargements in a patient's groin, axilla, mediastinum, and retroperitoneum at the first admission. Both F-fluorodeoxyglucose (FDG)-position emission tomography (PET) and lymph node biopsies supported the possible diagnosis of this case as a T-cell lymphoma, but no TCR gene rearrangement observed. Further examinations showed that serum IgG4 level of the patient was elevated and large amount of IgG4+ plasmocyte infiltration was detected in the involved lymph nodes, indicating this case as a possible IgG4-RD. However, the possibility of this disease as a T-cell lymphoma still could not be excluded. Tentatively, the patient was first treated as IgG4-RD with oral prednisone combined with methotrexate to avoid the unnecessary side effect of chemotherapy and economy burden. After three weeks treatment, the serum IgG4 level of the patient is evidently decreased and the enlarged lymph nodes disappeared as well. Eventually, we characterized this case as an atypical IgG4-related lymphadenopathy with 20 months' follow-up.

Background Disparities in multiple myeloma (MM) prognosis based on sociodemographic factors may exist. We investigated whether education level at diagnosis influenced Chinese MM patient outcomes.Methods We performed a multicenter retrospective analysis of data from 773 MM patients across 9 centers in China from 2006 to 2019. Sociodemographic and clinical factors at diagnosis and treatment regimens were recorded, and univariate and multivariate analyses were performed. Results Overall, 69.21% of patients had low education levels. Patients with low education levels differed from those with high education levels in that they were more likely to be older, and a higher proportion lived in rural areas, were unemployed, had lower annual incomes and lacked insurance. Additionally, compared to patients with high education levels, patients with low education levels had a higher proportion of international staging system (ISS) stage III classification and elevated lactate dehydrogenase (LDH) levels and underwent transplantation less often. Patients with high education levels had better progression-free survival (PFS) and overall survival (OS) than did patients with low education levels (67.50±8.10 versus 30.60±1.64 months; 122.27±0 versus 55.83±3.55 months, log-rank test, p<0.001; respectively). In the multivariable analysis, patients with high education levels had lower relapse and mortality rates than did those with low education level in terms of PFS and OS (hazard ratio (HR)=0.50 [95% confidence interval (CI): 0.34-0.72], p<0.001; HR=0.31 [0.18-0.53], p<0.001, respectively). Conclusions Low education levels may independently predict poor survival in MM patients in China. To reduce healthcare disparities for universal healthcare reform, it is critical to improve citizens’ education levels.