英国骨髓瘤联盟风险评分在初诊多发性老年骨髓瘤患者疗效及预后中的应用

An application of UK Myeloma Research Alliance Risk Profile for the evaluation of efficacy and prognosis in elderly patients with newly diagnosed multiple myeloma

目的明确英国骨髓瘤联盟风险评分(MRP)针对初诊多发性老年骨髓瘤(NDMM)患者是否具有评估预后、指导临床的意义。方法对2018年3月至2021年9月就诊的年龄≥65岁的NDMM患者应用MRP评分,分为低、中、高风险三组,分析其治疗疗效、不良反应及生存情况。结果共纳入63例患者,中位年龄69(65~84)岁,中位随访时间13.3(1.2~43.4)个月,MRP评分低风险组22例、中风险组13例、高风险组28例,三组患者的中位无进展生存时间(PFS)分别为38.4、25.1和21.2个月,2年PFS率分别为83.9%、60.0%、45.6%(P=0.177),2年总生存(OS)率分别为100.0%、90.0%、74.6%(P=0.049)。高、中、低风险组患者发生2级及以上血液学不良反应例数分别为20例(71.4%)、7例(53.8%)、8例(36.4%),差异有统计学意义(χ^(2)=6.154,P=0.046);发生3级及以上非血液学不良反应例数分别为17例(60.7%)、5例(38.5%)、5例(22.7%),差异有统计学意义(χ^(2)=7.389,P=0.025)。中、高风险组分别有6例(46.2%)、19例(67.9%)出现化疗中断、延迟或更换方案的情况,比例高于低风险组(31.8%,χ2=6.543,P=0.038)。结论对老年NDMM患者进行MRP评分具有可行性,MRP评分可用于预测患者发生化疗不良事件等,且对患者预后评估有一定价值。

Objective To evaluate the predictive value of the UK Myeloma Research Alliance Risk Profile(MRP)score based on clinical outcomes in elderly patients with newly diagnosed multiple myeloma(NDMM).Methods Patients aged≥65 years with NDMM in our hospital from March 2018 to September 2021 were divided into three groups with low,medium and high risk according to MRP scores.Their therapeutic efficacy,adverse effects,and survival were analyzed.Results A total of 63 NDMM patients were enrolled with median age of 69 years(65-84 years)and median follow-up of 13.3(1.2-43.4)months.Based on MRP score,there were 22 patients in the low-risk group,13 cases in medium-risk group,28 patients in the high-risk group.The median progression-free survival(PFS)time of the three groups was 38.4,25.1 and 21.2 months respectively,and the estimated 2-year PFS rate was 83.9%,60.0%,and 45.6%,respectively(all P=0.177).The estimated 2-year overall survival(OS)rate was 100.0%,90.0%,74.6%,respectively(all P=0.049).Among patients with grade 2 or above hematological adverse events,there were 20 cases(71.4%),7 cases(53.8%)and 8 cases(36.4%)in the high-,medium-and low-risk groups,with statistically significant differences(χ^(2)=6.154,P=0.046).Among patients with grade 3 or higher non-hematological adverse events,there were 17 cases(60.7%),5 case(38.5%)and 5 cases(22.7%)in the high-,medium-and low-risk groups,with statistically statistical significance(χ^(2)=7.389,P=0.025).The patients experiencing interruption,delay or replacement of chemotherapy regimen were 6 cases(46.2%)and 19 cases(67.9%)in the medium-and high-risk groups,which were higher than in the low-risk group(31.8%,χ^(2)=6.543,P=0.038).Conclusions It is feasible to conduct MRP score in elderly NDMM patients.The MRP score can be used to predict the adverse events of chemotherapy,etc,and has certain value for the prognosis evaluation of patients.