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Clinical outcomes and prognostic factors in patients with multiple myeloma in South Tyrol: a retrospective single-center analysis.
Annals of Hematology ( IF 3.5 ) Pub Date : 2020-03-05 , DOI: 10.1007/s00277-020-03969-9
Maximilian Mair 1 , Christian Straka 2 , Thomas Buratti 3 , Martina Tauber 4 , Manfred Mitterer 3 , Dominic Fong 3
Affiliation  

High-dose chemotherapy followed by autologous stem cell transplantation (HD-ASCT) as well as the introduction of novel agents (NA) significantly improved survival for patients with multiple myeloma (MM). A total of 150 unselected newly diagnosed MM patients treated at our institution from 1998 to 2017 were retrospectively analyzed. Median age at diagnosis was 69 years (range 33-93 years) with a median follow-up of 48.6 months. The median overall survival (OS) for the entire cohort was 60.7 months (range 0.3-280.1). Patients who received frontline HD-ASCT (p < 0.01) or NA-based first-line treatment (p = 0.043) had a significantly better OS. According to the revised Myeloma Comorbidity Index (R-MCI), patients were defined as fit (36.5%), intermediate-fit (44.5%), or frail (19%) with a significant difference in OS between these categories (p < 0.01). Multivariate analysis revealed R-MCI as an independent prognostic factor for OS (p < 0.01). Presence of subclinical amyloid deposits (A+) was detected in 18 out of 66 patients (27.3%) and significantly correlated with a serum free light chain (sFLC) ratio ≥ 100 (p = 0.01) and bone marrow plasma cell infiltration > 60% (p = 0.04). Furthermore, patients with A+ had significantly worse OS compared with their counterparts (p = 0.048). Our results corroborate the efficacy of both early HD-ASCT and the use of new agents as initial therapy of MM patients in "real-world" daily clinical practice. The R-MCI is an easily applicable tool to stratify MM patients and may support treatment decisions. The prognostic value of subclinical amyloid deposition should be validated within prospective studies.

中文翻译:

南蒂罗尔多发性骨髓瘤患者的临床结局和预后因素:回顾性单中心分析。

大剂量化疗后进行自体干细胞移植(HD-ASCT)以及新药(NA)的引入显着提高了多发性骨髓瘤(MM)患者的生存率。回顾性分析1998年至2017年在我院接受治疗的150例未选择的新诊断的MM患者。诊断时的中位年龄为69岁(范围33-93岁),中位随访时间为48.6个月。整个队列的中位总体生存期(OS)为60.7个月(范围0.3-280.1)。接受一线HD-ASCT(p <0.01)或基于NA的一线治疗(p = 0.043)的患者的OS明显好转。根据修订的骨髓瘤合并症指数(R-MCI),将患者定义为健康(36.5%),中等健康(44.5%)或体弱(19%),且这些类别之间的OS差异显着(p < 0.01)。多变量分析显示R-MCI是OS的独立预后因素(p <0.01)。66名患者中有18名(27.3%)检测到亚临床淀粉样蛋白沉积(A +),并且与血清游离轻链(sFLC)比率≥100(p = 0.01)和骨髓浆细胞浸润> 60%( p = 0.04)。此外,与同行相比,A +患者的OS明显较差(p = 0.048)。我们的结果证实了早期HD-ASCT的有效性以及在“现实世界”的日常临床实践中使用新药物作为MM患者的初始治疗的有效性。R-MCI是一种易于应用的工具,可以对MM患者进行分层,并且可以支持治疗决策。亚临床淀粉样蛋白沉积的预后价值应在前瞻性研究中得到验证。多变量分析显示R-MCI是OS的独立预后因素(p <0.01)。66名患者中有18名(27.3%)检测到亚临床淀粉样蛋白沉积(A +),并且与血清游离轻链(sFLC)比率≥100(p = 0.01)和骨髓浆细胞浸润> 60%( p = 0.04)。此外,与同行患者相比,A +患者的OS明显较差(p = 0.048)。我们的结果证实了早期HD-ASCT的有效性以及在“现实世界”的日常临床实践中使用新药物作为MM患者的初始治疗的有效性。R-MCI是一种易于应用的工具,可以对MM患者进行分层,并且可以支持治疗决策。亚临床淀粉样蛋白沉积的预后价值应在前瞻性研究中得到验证。多变量分析显示R-MCI是OS的独立预后因素(p <0.01)。66名患者中有18名(27.3%)检测到亚临床淀粉样蛋白沉积(A +),并且与血清游离轻链(sFLC)比率≥100(p = 0.01)和骨髓浆细胞浸润> 60%显着相关( p = 0.04)。此外,与同行相比,A +患者的OS明显较差(p = 0.048)。我们的结果证实了早期HD-ASCT的有效性以及在“现实世界”的日常临床实践中使用新药物作为MM患者的初始治疗的有效性。R-MCI是一种易于应用的工具,可以对MM患者进行分层,并且可以支持治疗决策。亚临床淀粉样蛋白沉积的预后价值应在前瞻性研究中得到验证。
更新日期:2020-03-05
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