Frailty评分预测老年多发性骨髓瘤的临床分析

Clinical analysis of the Frailty score in the prognosis of elderly multiple myeloma

目的:运用Frailty评分体系预测老年多发性骨髓瘤(multiple myeloma,MM)患者临床转归的研究分析。方法:对复旦大学附属中山医院血液科2015年1月1日至2016年2月29日收治的29例65岁以上老年MM患者进行Frailty评分,以分析其与患者临床转归的关系。结果:Frailty评分高危组13例(44.8%)、中危组5例(17.2%)、低危组11例(37.9%),3组患者在ISS分期(P=0.281)和化疗强度(P=0.475)上的差异无统计学意义。Frailty高危组患者不良反应较多,血液学3级及以上不良发生率(69.2%)显著高于低危组(18.2%,P=0.014)和中危组(0.0,P=0.011);高危组非血液学3级及以上不良反应发生率(84.6%)显著高于低危组(18.2%,P=0.001)和中危组(20.0%,P=0.011)。高危组中有69.2%的患者中断、延缓化疗或减小化疗强度,显著高于低危组(9.1%,P=0.004),与中危组差异无统计学意义(40.0%,P=0.268)。高危组患者化疗后获完全缓解(CR)及极好的部分缓解(VGPR)的患者占30.8%、部分缓解(PR)者占23.1%、无效(NR)者占46.2%,显著低于低危组(CR及VGPR 63.6%、PR 36.4%、NR 0.0,P=0.027),与中危组比较差异无统计学意义(CR及VGPR 40.0%、PR20.0%、NR 40.0%,P=0.751)。结论:Frailty评分体系可预测高危患者治疗的不良反应和疗效,高危患者预后差,但其对预后评估价值的大小有待更大样本量的阐明。

Objective：To analyze the Frailty score in the prognosis of elderly multiple myeloma.Methods：Twenty nine multiple myeloma patients aged above 65year-old admitted from January 1,2015 to February 29,2016 were enrolled in the study.Frailty score assessment was performed and its relation with clinical outcome was analyzed.Results：The 13 patients were classified into high risk group（44.8%）,5cases in mediate group（17.2%）,and 11 cases in low risk group（37.9%）.There were no statistical significance in the aspects of ISS stage（P=0.281）or chemotherapy intensity（P=0.475）found among the three groups.More patients（69.2%）in the Frailty high risk group suffered severe hematologic adverse events（≥grade 3）,which was significantly higher than low risk group（18.2%,P=0.014）and mediate risk group（0.0,P=0.011）.The occurrence of adverse reaction in severe non-hematologic group（≥grade 3）（84.6%）was higher than that of low risk group（18.2%,P=0.001）and that of mediate risk group（20.0%,P=0.011）.There were 69.2% of patients in high risk group had chemotherapy discontinuation,delay or chemotherapy intensity reduction,which was significantly higher than low risk group（9.1%,P=0.004）,and no statistical significance was observed in the mediate risk group（40.0%,P=0.268）.In the terms of therapy efficacy,30.8%,23.1%,and 46.2% patients obtained complete remission or very good remission（CR＋VGPR）,partial remission（PR）,and no remission（NR）in the high risk group,which were significantly lower than low risk group（CR＋VGPR 63.6%,PR 36.4%,NR 0.0,P=0.027）.No statistical significance of the efficacy was found between high risk group and mediate risk group（CR＋VGPR 40.0%,PR 20.0%,NR 40.0%,P=0.751）.Conclusions：The Frailty score can predict the adverse reaction and treatment efficacy,but with poor prognosis in high risk patients,and its clinical value in prognosis required further research.