新诊断多发性骨髓瘤患者的治疗模式和结局:一项来自县级医院血液科的回顾性研究

Treatment Patterns and Outcomes in Patients with Newly Diagnosed Multiple Myeloma:A Retrospective Study from a County-Level Hospital

目的评估单中心县级医院血液科新诊断多发性骨髓瘤(NDMM)的治疗模式及生存结局。方法回顾性分析2010年7月-2021年5月在阜宁县人民医院血液科接受至少2周期化疗的76例NDMM患者。结果患者的中位年龄为68(44~93)岁,其中>75岁的患者占16%;76例患者中,26例患者接受至少1次以蛋白酶体抑制剂(PI)为基础的化疗方案,33例接受至少1次以免疫调节剂(IMiD)为基础的化疗方案,其中,4例患者接受了来那度胺/硼替佐米/地塞米松(VRD)方案,21例患者接受传统化疗方案;中位随访时间77(95%CI56.3~97.7)个月,患者中位总生存(OS)时间为37(95%CI32.2~41.7)个月。早期死亡患者为3例(3.9%);5年0S为33%(95%CI21.24%~44.76%);单因素分析显示东部肿瘤协作组(ECOG)评分、国际分期系统(ISS)分期和三药联合影响预后;多因素分析显示ECOG评分3~4(HR=16.810,95%CI2.011~140.498,P=0.009)、ISSⅢ期(HR=3.722,95%CI1.088~12.734,P=0.036)和三药联合(HR=7.137,95%CI 1.331~38.273,P=0.022)影响MM患者OS。结论MM的预后因素由宿主因素、肿瘤特征及化疗方案综合决定。

Objective To assess treatment pattens and outcomes of patients with newly diagnosed multiple myeloma(NDMM)from a single center at the county-level.Methods 76 patients with NDMM who received at least two cycle of chemotherapy were retrospectively analyzed between July 2010 and May 2021.Results Median age was 68(range 44-93)years and 16%patients were more than 75 years.26 patients underwent at least one cycle of Bortezomib based regimen,while 33 patients received at least one cycle of immunomodulatory agents based regimen.4 patients received Lenalidomide plus Bortezomib plus Dexamethasone while 21 patients received triplet regimens without Bortezomib or immunomodulatory agents.Median overall survival(OS)was 37 months(95%CI 32.2-41.7).5-year survival rate was 33%(95%CI 21.24%-44.76%).3(3.9%)patients developed early death.The univariate analysis revealed that Eastern Cooperative Oncology Group performance status(ECOG PS)3-4,international staging system(ISS)stage and triplet regimens were the risk factors for the prognosis of patients with MM.The multivariate analysis revealed that ISS stageⅢ(HR=3.722,95%CI 1.088-12.734,P=0.036),ECOG PS 3-4(HR=16.810,95%CI 2.011-140.498,P=0.009),and triplet regimens(HR=7.137,95%CI 1.331-38.273,P=0.022)were the independent prognostic risk factors of patients with MM.Conclusion MM prognosis depends on host,tumor characteristics and regimens.