93例70岁以上多发性骨髓瘤患者的临床特点及转归  

Clinical features and prognosis of 93 elderly patients with multiple myeloma

作　　者：陈海敏[1] 周帆[1] 韦苇[1] 彭嵘[1] 石昊天 侯健[2] 

机构地区：[1]第二军医大学长征医院闸北分院血液科,上海200070 [2]第二军医大学长征医院血液科

出　　处：《中华血液学杂志》2017年第9期744-748,共5页Chinese Journal of Hematology

基　　金：上海市科委科研计划（14411973400）;上海市静安区医学科研青年项目（2016QN04）

摘　　要：目的探索老年多发性骨髓瘤（MM）患者的临床特征以及转归。方法回顾性分析2011年8月至2016年8月第二军医大学长征医院收治的93例70岁以上的初发MM患者的临床特征，根据患者初发时的年龄、日常生活能力评分、日常生活能力量表、Charlson合并症指数，按照Palumbo等提出的健康评估系统，将评分为0分的归为健康，评分为1分的归为中等健康，评分i〉2分的归为健康状况差。分析三组患者的治疗反应率、疾病无进展生存（PFS）时间以及总生存（Os）时间。结果93例患者中，健康、中等健康、健康状况差组分别为15例、31例和47例，三组完全缓解（CR）率分别为60．0％、22．6％、12．8％（Fisher χ2=12．398，P=0．002）。三组的中位PFS时间分别为31、24和13个月（χ2=17．832，P〈0．001），中位OS时间分别为未达到、58个月和25个月（χ2=40．678，P〈0．001）。在47例健康状况差的患者中，应用含有新药（蛋白酶体抑制剂或免疫调节剂）化疗方案的较未应用新药的患者可获得更长PFS时间（17个月对9个月，χ2=6．454，P=0．011）；CR患者PFS和OS时间均明显长于未达CR的患者（PFS：24个月对12个月，χ2=4．117，P=0．042；OS：37个月对25个月，χ2=6．507，P=0．011）。结论健康状况影响老年MM患者的治疗反应率、PFS及OS。对健康状况差的老年MM患者，使用含有新药的化疗方案可延长PFS时间，且获得CR的患者PFS及OS时间更长。Objective To explore the clinical features and prognostic factors of elderly MM patients. Methods A retrospectively analysis of clinical characteristics in 93 newly diagnosed MM patients with more than 70 years of old between August 2011 and August 2016. Based on age, basic activities of daily living scale, instrumental activities of daily living scale, Charlson comorbidity index at diagnosis, patients were divided into three groups： Fit （score = 0, n = 15）, Intermediate fitness （score = 1, n = 31 ）, Frail （score≥2, n = 47） according to a geriatric assessment system proposed by Antonio Palumbo et al. The treatment response rate, progression free survival time （PFS） and overall survival （OS） of the three groups were analyzed. Results Complete remission was 60.0% in Fit, 22.6% in Intermediate fitness and 12.8% in Frail （Fisher χ2 = 12.398, P = 0.002）. The median PFS for the three groups were 31 months, 24 months and 13 months （χ2 = 17.832, P 〈 0.001 ）. The median OS was not reached for Fit, 58 months for Intermediate fitness and 25 months for Frail （χ2 = 40.678, P〈 0.001 ）. In 47 Frail cases, patients who received chemotherapy containing new drugs （proteasome inhibitor or immune-modulator） had a longer PFS （ 17 months vs 9 months,χ2= 6.454, P = 0.011 ） and patients who achieved CR had prolonged PFS and OS than non-CR （PFS： 24 months vs 12 months,χ2= 4.117, P= 0.042; OS： 37 months vs 25 months, χ2 = 6.507, P = 0.011 ）. Conclusion The health status of the elderly MM patients was associated with better response and longer PFS and OS. Given on those with poor health status, new drugs may have better PFS and prolonged OS.

关 键 词：多发性骨髓瘤 日常生活能力评分 日常生活能力量表 Charlson合并症指数 

分 类 号：R733.3[医药卫生—肿瘤]