中国全科医学 ›› 2024, Vol. 27 ›› Issue (08): 971-977.DOI: 10.12114/j.issn.1007-9572.2023.0313

• 论著·专病管理·多发性骨髓瘤 • 上一篇    下一篇

初诊超高龄多发性骨髓瘤患者硼替佐米基础方案治疗的生存预后分析

赵凤仪, 李新, 詹晓凯, 张佳佳, 申曼, 汤然, 范斯斌, 黄仲夏*()   

  1. 100020 北京市,首都医科大学附属北京朝阳医院血液与肿瘤科
  • 收稿日期:2023-05-29 修回日期:2023-08-04 出版日期:2024-03-15 发布日期:2023-12-19
  • 通讯作者: 黄仲夏

  • 作者贡献:赵凤仪提出探索超高龄老年多发性骨髓瘤的衰弱评分与预后相关性的研究思路,设计研究方案,数据整理、统计分析;李新、詹晓凯、张佳佳负责研究过程实施,图表绘制;申曼、汤然、范斯斌负责病例数据收集、电话随访、SPSS软件应用;赵凤仪、李新、詹晓凯、张佳佳、申曼、汤然、范斯斌负责论文起草;黄仲夏负责论文最终版修订,对整体研究思路把控并对论文负责,监督管理。
  • 基金资助:
    北京市科技计划项目(Z171100000417010); 北京市石景山区卫生与健康委员会医学重点学科建设项目(石卫健医发〔2021〕2号); 首都医科大学附属北京朝阳医院金种子科研基金(CYJZ202113)

Survival and Prognosis Analysis of Bortezomib Based Regimen in Newly Diagnosed Super-aged Multiple Myeloma Patients

ZHAO Fengyi, LI Xin, ZHAN Xiaokai, ZHANG Jiajia, SHEN Man, TANG Ran, FAN Sibin, HUANG Zhongxia*()   

  1. Department of Hematology and Oncology, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China
  • Received:2023-05-29 Revised:2023-08-04 Published:2024-03-15 Online:2023-12-19
  • Contact: HUANG Zhongxia

摘要: 背景 多发性骨髓瘤(MM)是一种高度异质性疾病,超高龄老年MM患者是一类特殊群体,其治疗决策和一般评价缺乏一定的循证医学依据,在衰弱评估方面也有一定争议。 目的 分析以硼替佐米为基础方案治疗初诊超高龄MM患者的一般临床特征和生存预后的影响因素,同时评价超高龄MM患者一般状况的最佳评估模式。 方法 回顾性分析2013年11月—2023年1月于首都医科大学附属北京朝阳医院石景山院区收治的29例初诊超高龄MM患者病例资料,通过首都医科大学附属北京朝阳医院病案系统进行生存随访,随访截至2023-04-01,本研究结局终点为总生存期(OS)和无进展生存期(PFS)。根据治疗方案将患者分为两药治疗组(n=18)和三药治疗组(n=11),比较两组患者临床和遗传学特征。采用老年评分系统(GA)评分、英国骨髓瘤研究联盟风险状况(MRP)评分和梅奥(Mayo)评分评估患者的衰弱状态,并进行疗效评价。采用Kaplan-Meier法绘制MM患者OS和PFS的生存曲线,不同影响因素的生存曲线比较采用Log-rank检验,采用多因素Cox比例风险回归分析探讨MM患者OS和PFS的影响因素。 结果 随访中位PFS为8.70(1.90~43.87)个月,中位OS为17.23(2.00~72.83)个月。至末次随访,共21例(72.41%)患者出现疾病进展(PD)或复发,12例(41.38%)患者死亡;一线治疗客观缓解率(ORR)为82.76%(24/29),部分缓解(PR)率为51.72%(15/29),非常好的部分缓解(VGPR)率为24.14%(7/29),完全缓解(CR)率为6.90%(2/29)。两组初诊超高龄MM患者CR率、VGPR率、PR率、ORR比较,差异均无统计学意义(P>0.05)。多因素Cox比例风险回归分析结果显示,MRP衰弱(HR=0.213,95%CI=0.049~0.924,P=0.039)、血清校正钙升高(HR=0.153,95%CI=0.041~0.570,P=0.005)和维持治疗(HR=4.301,95%CI=1.219~15.169,P=0.023)是初诊超高龄MM患者PFS的独立影响因素;维持治疗(HR=4.372,95%CI=1.049~18.221,P=0.043)是初诊超高龄MM患者OS的独立影响因素。 结论 含硼替佐米两药或三药治疗方案对初诊超高龄MM疗效和预后影响无明显差异,血清校正钙升高和维持治疗是影响生存的独立预后因素;MRP评分可用于评估初诊超高龄MM患者预后。

关键词: 多发性骨髓瘤, 硼替佐米, 预后, 衰弱, 老年人,80以上, 总生存期, 无进展生存期

Abstract:

Background

Multiple myeloma is a highly heterogeneous disease. Super-aged patients with multiple myeloma are a special group. There is a lack of evidence-based medical basis in the treatment decision and general evaluation of them, and there is also some controversy in the assessment of frailty.

Objective

To explore the clinical features and the influencing factors of survival and prognosis in newly diagnosed super-aged multiple myeloma (MM) patients with the bortezomib based regimen and to evaluate the best assessment model for the general status of patients with MM.

Methods

The clinical data of newly diagnosed super-aged patients with MM in Beijing Chao-yang Hospital, Capital Medical University from November 2013 to January 2023 were retrospectively analyzed. Survival follow-up was conducted through the medical record system of Beijing Chao-Yang Hospital, Capital Medical University until April 1, 2023, with the end points of this study of overall survival (OS) and progression-free survival (PFS) . The patients were divided into the two-drug treatment group (n=18) and three-drug treatment group (n=11) , and the clinical and genetic characteristics of the two groups were compared. The Geriatric Assessment System (GA) score, UK Myeloma Research Alliance Risk Profie (MRP) score, and Mayo score were used to evaluate the frailty status and treatment efficacy. Survival curves of OS and PFS in MM patients were plotted using the Kaplan-Meier method. Log-rank test was used to compare the survival curves of different influencing factors. Multivariate Cox hazard risk regression analysis was used to explore the influencing factors of OS and PFS in MM patients.

Results

The median PFS was 8.70 (1.90-43.87) months and the median OS was 17.23 (2.00-72.83) months. A total of 21 (72.41%) patients experienced disease progression (PD) or relapse, and 12 (41.38%) patients died by the final follow-up. The objective remission rate (ORR) for first-line treatment was 82.76% (24/29) , the partial remission (PR) rate was 51.72% (15/29) , the very good partial remission (VGPR) rate was 24.14% (7/29) , and the complete remission (CR) rate was 6.90% (2/29) . There was no significant difference in CR rate, VGPR rate, PR rate and ORR between the two groups of newly diagnosed super-aged MM patients (P>0.05) . Multivariate Cox hazard risk regression analysis showed that MRP debilitation (HR=0.213, 95%CI=0.049-0.924, P=0.039) , elevated serum corrected calcium (HR=0.153, 95%CI=0.041-0.570, P=0.005) and maintenance therapy (HR=4.301, 95%CI=1.219-15.169, P=0.023) were independent influencing factors of PFS in newly diagnosed super-aged MM patients, while maintenance treatment (HR=4.372, 95%CI=1.049-18.221, P=0.043) was an independent influencing factor for OS in newly diagnosed super-aged MM patients.

Conclusion

There is no significant difference in the efficacy and prognostic impact of two-drug or three-drug Bortezomib based treatment. Serum corrected calcium elevation and maintenance therapy are independent prognostic factors for survival. MRP score can be used to assess the prognosis of newly diagnosed super-aged MM patients.

Key words: Multiple myeloma, Bortezomib, Prognosis, Frailty, Aged, 80 and over, Overall survival, Progression-free survival