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Abstract：
Therapeutic practices for multiple myeloma (MM) have evolved, such that novel-agent-based therapy and autologous peripheral blood stem cell transplantation (aPBSCT) is the current standard. Whether cause-specific mortality has changed with time remains unclear. We examined late cause-specific mortality among patients with MM receiving aPBSCT from 1989 to 2014. We conducted a prospective cohort study using participants enrolled in the enrolled in the Blood or Marrow Transplant Survivor Study. We created 3 eras to reflect changing MM therapy: <2000 (pre-thalidomide); 2000-2005 (thalidomide); 2006-2014 (lenalidomide). We used Kaplan-Meier techniques and Cox regression for examining all-cause mortality, and subdistribution hazards models for cause-specific mortality. In total, 1906 patients were followed up for a median of 9.2 years. Conditional on surviving 2 years, the 10-year overall survival was 45%. The 10-year cumulative incidence of myeloma- and non-myeloma-related mortality was 33% and 13%, respectively. Multivariable analysis showed declining MM-specific mortality (subdistribution hazard ratio [SHR]2000-2005 = 0.80, 95% confidence interval [CI], 0.60-1.07; SHR2006-2014 = 0.46, 95% CI, 0.34-0.62; referent group: <2000), infection-related mortality (SHR2000-2005 = 0.50, 95% CI, 0.29-0.85; SHR2006-2014 = 0.35, 95%CI 0.21-0.60; referent group: <2000) and cardiovascular disease-related mortality (SHR2000-2005 = 0.45, 95% CI 0.20-0.99; SHR2006-2014 = 0.41, 95% CI 0.18-0.93; referent group: <2000). Although primary disease remains the major cause of late mortality, we observed a significant temporal decline in myeloma-, infection-, and cardiac-related late mortality over the past 25 years.
摘要：
多发性骨髓瘤（MM）的治疗实践已经发展，因此，基于新药的治疗和自体外周血干细胞移植（aPBSCT）是当前的标准。原因特异性死亡率是否随时间而变化尚不清楚。我们检查了1989年至2014年接受aPBSCT的MM患者的晚期原因特异性死亡率。我们使用血液或骨髓移植幸存者研究中的参与者进行了一项前瞻性队列研究。我们创建了3个时代来反映MM治疗的变化：<2000（沙利度胺）;2000-2005（沙利度胺）;2006-2014（来那度胺）。我们使用Kaplan-Meier技术和Cox回归检查全因死亡率，和特定原因死亡率的亚分布风险模型。总的来说,1906例患者的中位随访时间为9.2年。以存活2年为条件,10年总生存率为45%.骨髓瘤和非骨髓瘤相关死亡率的10年累积发病率分别为33%和13%。分别。多变量分析显示MM特异性死亡率下降(子分布危险比[SHR]2000-2005=0.80，95%置信区间[CI]，0.60-1.07；SHR2006-2014=0.46，95%CI，0.34-0.62；参考组：<2000），感染相关死亡率(SHR2000-2005=0.50,95%CI,0.29-0.85;SHR2006-2014=0.35,95CI0.21-0.60;参考组:<2000)和心血管疾病相关死亡率(SHR2000-2005=0.45,95%CI0.20-0.99;SHR2006-2014=0.41,95%CI0.18-0.93;参考组:<2000).尽管原发性疾病仍然是晚期死亡的主要原因，我们观察到骨髓瘤的时间显着下降，感染-,和心脏相关的晚期死亡率在过去的25年。
