Abstract：
The use of proteasome inhibitors (PIs), new immune modulators (IMiDs), and other new drugs, as well as high-dose chemotherapy combined with autologous stem cell transplantation has considerably improved the survival of young patients with multiple myeloma (MM). However, the improvement in survival among elderly patients remains insufficient. Optimal treatment recommendation models for elderly patients with MM have not been developed especially there are quite few study in the real world.
We retrospectively analyzed the treatment patterns and outcomes of 328 Chinese patients (≥65 years) with MM in a real-world setting. Patients were divided into three groups according to induction regimens.
The median age of the cohort was 70 (65-86) years. The patients were divided into group 1 (PIs based regimens, n = 218), group 2 (IMiDs based regimens, n = 48) and group 3 (PIs + IMiDs, n = 62). Induction regimens in group 3 produced higher overall response rate than group 1 and 2 (85.42% vs. 71.08% vs. 66.67%, p = 0.016). The median follow-up of the cohort was 30 (interquartile range [IQR] 18-36) months. For the entire cohort median progression-free survival (PFS) was 26 (IQR 12.00-42.89) months and overall survival (OS) was 60 (IQR 40.00-67.20) months. The PFS were not significantly different among the three groups (28 months vs. 18 months vs. 26 months, p = 0.182). So were the OS (60 months vs. 59 months vs. not reached, p = 0.067). Multivariate analysis revealed that age >70 year, frailty status (Geriatric vulnerability score), induction efficacy < partial remission, and no maintenance treatment were independent poor prognostic factors for OS.
Front-line induction regimens combining PIs and IMiDs developed more deep response than single PI or IMiD based regimens. Maintenance treatment can further improve the clinical outcome in elderly MM patients in real-world setting.
We retrospectively analyzed the treatment patterns and outcomes of 328 Chinese patients (≥65 years) with MM in a real-world setting. Patients were divided into three groups according to induction regimens.
The median age of the cohort was 70 (65-86) years. The patients were divided into group 1 (PIs based regimens, n = 218), group 2 (IMiDs based regimens, n = 48) and group 3 (PIs + IMiDs, n = 62). Induction regimens in group 3 produced higher overall response rate than group 1 and 2 (85.42% vs. 71.08% vs. 66.67%, p = 0.016). The median follow-up of the cohort was 30 (interquartile range [IQR] 18-36) months. For the entire cohort median progression-free survival (PFS) was 26 (IQR 12.00-42.89) months and overall survival (OS) was 60 (IQR 40.00-67.20) months. The PFS were not significantly different among the three groups (28 months vs. 18 months vs. 26 months, p = 0.182). So were the OS (60 months vs. 59 months vs. not reached, p = 0.067). Multivariate analysis revealed that age >70 year, frailty status (Geriatric vulnerability score), induction efficacy < partial remission, and no maintenance treatment were independent poor prognostic factors for OS.
Front-line induction regimens combining PIs and IMiDs developed more deep response than single PI or IMiD based regimens. Maintenance treatment can further improve the clinical outcome in elderly MM patients in real-world setting.
摘要：
蛋白酶体抑制剂（PIs）的使用，新的免疫调节剂（IMiDs），和其他新药，大剂量化疗联合自体干细胞移植显著提高了年轻多发性骨髓瘤(MM)患者的生存率.然而,老年患者的生存率改善仍然不足.尚未开发出针对老年MM患者的最佳治疗推荐模型，尤其是在现实世界中的研究很少。
我们回顾性分析了328例（≥65岁）MM患者在真实世界中的治疗模式和结果。根据诱导方案将患者分为三组。
该队列的中位年龄为70（65-86）岁。将患者分为第1组(基于PI的方案，n=218),第2组(基于IMID的方案，n=48)和第3组(PI+IMiD，n=62）。第3组的诱导方案产生的总反应率高于第1组和第2组(85.42%vs.71.08%与66.67%，p=0.016)。该队列的中位随访时间为30个月（四分位距[IQR]18-36）。对于整个队列，中位无进展生存期（PFS）为26（IQR12.00-42.89）个月，总生存期（OS）为60（IQR40.00-67.20）个月。三组的PFS无显著差异(28个月vs.18个月vs.26个月,p=0.182）。操作系统也是如此(60个月vs.59个月vs.没有到达,p=0.067)。多变量分析表明，年龄>70岁，虚弱状态(老年脆弱性评分)，诱导功效<部分缓解，无维持治疗是OS预后不良的独立因素。
组合PI和IMiD的一线诱导方案比基于单一PI或IMiD的方案产生了更深的反应。维持治疗可以进一步改善真实世界中老年MM患者的临床结果。
我们回顾性分析了328例（≥65岁）MM患者在真实世界中的治疗模式和结果。
该队列的中位年龄为70（65-86）岁。
组合PI和IMiD的一线诱导方案比基于单一PI或IMiD的方案产生了更深的反应。
