Supplementary Material and Methods
Comorbidity description and assessment
The KPS was defined as either normal with 100%, negligibly impaired with 80-90% or moderately to
substantially impaired ≤70%. Lung impairment was scored as mild with presence of dyspnea upon
intense activity and/or FEV1/VC <70% and FEV1 ≥80% (FEV1 % predicted), as moderate with dyspnoea
upon moderate activity and/or FEV1/VC <70% and FEV1 >50% and <80%, or dyspnoea at rest or few
steps of walking and/or need for oxygen/non invasive ventilation and/or FEV1 <50%.1, 2 Renal function
was determined via eGFR (MDRD).3-5 Cardiac function was defined as minor with evidence of coronary
artery disease without heart attack or angina pectoris (no significant stenosis), as moderate with past (>6
months) myocardial infarction (MI) with angina pectoris not requiring hospitalization, and as severe with
symptomatic congestive heart failure, ejection fraction ≤40%, MI, angina pectoris requiring hospitalization
or significant arrhythmias within the past 6 months. Hypertension was defined as moderate vs. severe
with systolic values >130 and >150mmHg, respectively. Hepatic comorbidity was scored as mild with
steatosis without signs of chronic liver disease (no persistent elevated liver enzymes), as moderate with
chronic hepatitis (bilirubin >upper limit of normal [ULN] to 1.5xULN, or aspartate aminotransferase
[AST]/alanine aminotransferase [ALT] >ULN to 2.5xULN), and as severe with cirrhosis, fibrosis with portal
hypertension and/or esophageal varices (bilirubin >1.5xULN, or AST/ALT >2.5xULN). Pain was assessed
when requiring pain medication and as persistent under medication. Evidence of additional malignancies
was assessed as described.6 Risk stratification for age >60 years was based on prior results.7,
8
Laboratory data comprised serum creatinine and ß2-MG. Due to the data assessment between 1997 and
2003, routine ß2-MG- and albumin-levels were not available in all patients, therefore the ISS was based
on 75 patients. Cytogenetics (via Fluorescence in situ hybridization [FISH]) were available in 56
patients,9-11 since cytogenetics were not routinely assessed between 1997 and 2003.
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