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  

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

作　　者：赵凤仪 李新[1] 詹晓凯[1] 张佳佳[1] 申曼[1] 汤然 范斯斌 黄仲夏[1] ZHAO Fengyi;LI Xin;ZHAN Xiaokai;ZHANG Jiajia;SHEN Man;TANG Ran;FAN Sibin;HUANG Zhongxia(Department of Hematology and Oncology,Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院血液与肿瘤科,北京市100020

出　　处：《中国全科医学》2024年第8期971-977,共7页Chinese General Practice

基　　金：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)。

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�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.Logrank 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

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 

分 类 号：R733.3[医药卫生—肿瘤]