不同衰弱评分下老年多发性骨髓瘤患者化疗疗效及安全性的评估

Evaluation of the Efficacy and Safety of Chemotherapy in Elderly Patients with Multiple Myeloma under Different Frailty Scores

目的:比较老年多发性骨髓廇(MM)患者不同衰弱评分下不同化疗方案的疗效及安全性。方法:回顾性分析老年MM患者的临床资料,包括年龄、治疗方案、疗效、不良反应以及衰弱评分,包含日常生活能力评分、日常生活活动能力量表及Charlson合并症指数,按照评分标准将患者分为身体状态良好、欠佳及虚弱3组。统计分析不同体质状况的老年MM不同化疗方案的治疗有效率、1年总生存率及不良反应发生率。结果:70例患者中,身体状态良好、欠佳和虚弱组的治疗有效率分别为79.5%、81%和40%。良好患者中二联组和三联组的有效率分别为54.5%、89.3%,欠佳患者中分别为70%、90.9%,虚弱患者中为42.9%和33.3%,良好患者中三联方案优势明显,较二联方案差异有统计学意义(P<0.05),而欠佳患者和虚弱患者二联、三联化疗方案疗效差异不显著。在硼替佐米诱导期间,三联组的不良反应发生率(78.6%)高于二联组(67.9%),但比较差异无统计学意义(P>0.05),各组间1年总生存率及伴有分子遗传学异常的MM患者选用不同治疗方案的疗效无明显差异。结论:疗效与患者的体质状况相关,对于体质良好的患者,应优先使用三联方案,对于体质虚弱的患者,应从安全性考虑,选择药物毒性小的化疗方案。

Objective:To compare the efficacy and safety of different chemotherapy regimens in elderly multiple myeloma(MM) patients with different Frailty scores.Methods:The clinical data of elderly patients with MM were retrospectively analyzed,including age,treatment regimen,efficacy,adverse reactions,and the Frailty score included in the activity of daily living score,the instrumental activity of daily living scale and the Charlson comorbidity index.The patients were divided into fit group,mediate fit group and frail group according to the scoring standard.The treatment efficiency and adverse reaction rates of elderly MM with different physical conditions treated by different chemotherapy regimens were analyzed.Results:Among the 70 patients,the effective rates of the patients in fit group,the mediate fit group,and the frail group were 79.5%,81%,and 40%,and the effective rates of the fit patients in double and triple groups were 54.5% and 89.3%,70% and 90.9% for mediate fit patients,42.9% and 33.3% for frail patients,the triple regimen in fit patients showed obvious advantages,and the difference showed statistically significant(P<0.05),while the efficacy for mediate patients and frail patients showed no significant difference.During the induction of bortezomib,the incidence of adverse reactions for the patients in the triple group(78.6%) was higher than 67.9% in the double group,and the difference showed no statistically significant(P>0.05).There was no significant difference in the 1-year overall survival rate of the patients and with molecular genetic abnormalities among each groups.Conclusion:The therapeutic effect is related to the patient’s physical condition.For patients with healthy physique,the triple regimen should be used first.For patients with weak physical constitution,the chemotherapy regimen with low drug toxicity should be selected for safety.