80岁以上高龄老年多发性骨髓瘤11例临床分析

Clinical analysis of multiple myeloma in patients over 80 years old:A report of 11 cases

目的：探讨80岁以上高龄老年多发性骨髓瘤的临床特点。方法：对本院2000年12月至2013年12月收治的11例80岁以上多发性骨髓瘤患者的临床资料进行回顾性分析。结果：11例老年多发性骨髓瘤平均年龄为（83．5±3．4）岁，所有患者至少合并2个以上其他基础性疾病。DS分期Ⅲ期为8例、ISS分期Ⅲ期7例。共10例患者接受了个体化的治疗方案，无效进展3例，CR1例，PR3例，MR4例。中位生存28（2～97）个月，1、2、3年生存率分别为72．7％、54．5％、36.3％。因疾病进展导致死亡的6例，疾病稳定期因肺炎死亡3例、AMI死亡2例。结论：高龄老年多发性骨髓瘤分期较晚，临床表现不典型。治疗应根据患者情况进行个体化的治疗，感染和心血管并发症较常见且是主要死亡原因。经过个体化治疗及有效的支持治疗，生存期得到明显延长，尤其是I～Ⅱ期患者经个体化治疗后生存期可接近5年。

Objective： This study aimed to explore clinical features of multiple myeloma in patients over 80 years old. Methods： We retrospectively analyzed 11 cases of multiple myeloma over 80 years old, which were diagnosed from 2000 to 2013 in our hospital. Results： The mean age was 83.5 years. All patients had more than two complicated diseases, and the performance status was poor in the majority of the patients. Ten cases received individualized treatments. The results showed that three patients had progressed, one patient achieved complete remission, three patients achieved partial remission, and four patients achieved minor remission. Median survival time was 28 months. The causes of death included six progressed myelomas, three pneumonias, and two acute myocardial infarctions. Conclusion： Patients aged 80 years old with myeloma are often at a late stage. Treatment should be individualized based on patient status. Survival time was evidently prolonged in very elderly patients with MM after individualized treatments, particularly in patients in stages Ⅰ and Ⅱ.