Abstract：
UNASSIGNED: Multiple myeloma is a highly heterogenous plasma cell malignancy, commonly seen in older patients. Age is one of the important prognostic factors. However, nearly all the prognostic staging systems are based on clinical trials, where patients were relatively fit and young. It is unknown how the presence of biochemical or cytogenetic prognostic factors and their risk weights changes with older age. To further investigate this question, we retrospectively analyzed the data from a consecutive cohort of patients treated with either bortezomib or thalidomide-based therapy.
UNASSIGNED: This retrospective study was carried out on a cohort of 1125 newly diagnosed multiple myeloma patients, from January 2008 to December 2019. Patients received bortezomib or thalidomide-based induction and maintenance therapy. Patients accepted hematopoietic stem cell transplantation if eligible. Statistical analysis was conducted by Stata/MP 16.0 and SPSS 26.0.
UNASSIGNED: With age increasing, the proportion of patients with ISS 3, performance status score ≥2, and the incidence rate of gain(1q) significantly increased. We also found that ISS became less important in older patients. However, cytogenetic abnormalities exerted a consistently adverse impact on survival, both in young and old patients. Older patients had an inferior outcome than their young counterparts. All patients in our cohort benefitted more from bortezomib than thalidomide-based induction therapy, except for patients ≥71 years old.
UNASSIGNED: ISS may lose prognostic value in patients ≥71 years old. Older patients had an inferior outcome and needed more effective and less toxic treatment.Plain Language SummaryMultiple myeloma is a type of blood cancer commonly seen in older people. To treat this disease, genetic abnormality, the poor physical status of patients and the abundance of tumor cells are the main difficulties. We often draw these conclusions from clinical trials. However, clinical trials always enrolled relatively younger patients, so the presence and significance of these factors may vary from clinical trials to the real world. We conducted the study to find out the real risk in both young and old patients. We found that older patients were more likely to have anemia, poor nutritional status and renal function. We also found older patients had more risk of relapse, progression or death than young patients. Frail physical status is the key obstacle to treating older patients, and tumor burden no longer impacts the outcome of these people. Bortezomib is a powerful drug to treat this disease, but patients ≥71 years old had less benefit than younger ones. More studies should focus on older or frail patients as these patients need more effective and less toxic treatment.
UNASSIGNED: This retrospective study was carried out on a cohort of 1125 newly diagnosed multiple myeloma patients, from January 2008 to December 2019. Patients received bortezomib or thalidomide-based induction and maintenance therapy. Patients accepted hematopoietic stem cell transplantation if eligible. Statistical analysis was conducted by Stata/MP 16.0 and SPSS 26.0.
UNASSIGNED: With age increasing, the proportion of patients with ISS 3, performance status score ≥2, and the incidence rate of gain(1q) significantly increased. We also found that ISS became less important in older patients. However, cytogenetic abnormalities exerted a consistently adverse impact on survival, both in young and old patients. Older patients had an inferior outcome than their young counterparts. All patients in our cohort benefitted more from bortezomib than thalidomide-based induction therapy, except for patients ≥71 years old.
UNASSIGNED: ISS may lose prognostic value in patients ≥71 years old. Older patients had an inferior outcome and needed more effective and less toxic treatment.Plain Language SummaryMultiple myeloma is a type of blood cancer commonly seen in older people. To treat this disease, genetic abnormality, the poor physical status of patients and the abundance of tumor cells are the main difficulties. We often draw these conclusions from clinical trials. However, clinical trials always enrolled relatively younger patients, so the presence and significance of these factors may vary from clinical trials to the real world. We conducted the study to find out the real risk in both young and old patients. We found that older patients were more likely to have anemia, poor nutritional status and renal function. We also found older patients had more risk of relapse, progression or death than young patients. Frail physical status is the key obstacle to treating older patients, and tumor burden no longer impacts the outcome of these people. Bortezomib is a powerful drug to treat this disease, but patients ≥71 years old had less benefit than younger ones. More studies should focus on older or frail patients as these patients need more effective and less toxic treatment.
摘要：
■多发性骨髓瘤是一种高度异质性的浆细胞恶性肿瘤，常见于老年患者。年龄是影响预后的重要因素之一。然而,几乎所有的预后分期系统都是基于临床试验，患者相对健康和年轻。尚不清楚生化或细胞遗传学预后因素的存在及其风险权重如何随着年龄的增长而变化。为了进一步研究这个问题，我们回顾性分析了接受硼替佐米或沙利度胺治疗的连续队列患者的数据.
■这项回顾性研究是对1125例新诊断的多发性骨髓瘤患者进行的，从2008年1月到2019年12月。患者接受基于硼替佐米或沙利度胺的诱导和维持治疗。如果符合条件，患者接受造血干细胞移植。采用Stata/MP16.0和SPSS26.0进行统计学分析。
■随着年龄的增长，ISS3、性能状态评分≥2分和增益发生率(1q)的患者比例显著增加。我们还发现，ISS在老年患者中变得不那么重要。然而,细胞遗传学异常对生存产生了一贯的不利影响，无论是年轻人还是老年人。老年患者的预后比年轻患者差。与基于沙利度胺的诱导治疗相比，我们队列中的所有患者从硼替佐米中受益更多。除了≥71岁的患者。
■ISS可能在≥71岁的患者中失去预后价值。老年患者的预后较差，需要更有效且毒性更低的治疗。多发性骨髓瘤是一种常见于老年人的血癌。为了治疗这种疾病，遗传异常,患者身体状况差和肿瘤细胞丰富是主要困难。我们经常从临床试验中得出这些结论。然而,临床试验总是招募相对年轻的患者，因此，这些因素的存在和意义可能会有所不同，从临床试验到现实世界。我们进行了这项研究，以找出年轻和老年患者的真正风险。我们发现老年患者更容易患贫血,营养状况和肾功能差。我们还发现老年患者复发的风险更大，进展或死亡比年轻患者。身体虚弱是治疗老年患者的主要障碍，肿瘤负担不再影响这些人的预后。硼替佐米是治疗这种疾病的有效药物，但≥71岁的患者比年轻患者获益较少.更多的研究应该集中在老年或虚弱的患者，因为这些患者需要更有效和毒性更低的治疗。
■这项回顾性研究是对1125例新诊断的多发性骨髓瘤患者进行的，从2008年1月到2019年12月。患者接受基于硼替佐米或沙利度胺的诱导和维持治疗。如果符合条件，患者接受造血干细胞移植。采用Stata/MP16.0和SPSS26.0进行统计学分析。
■随着年龄的增长，ISS3、性能状态评分≥2分和增益发生率(1q)的患者比例显著增加。我们还发现，ISS在老年患者中变得不那么重要。然而,细胞遗传学异常对生存产生了一贯的不利影响，无论是年轻人还是老年人。老年患者的预后比年轻患者差。与基于沙利度胺的诱导治疗相比，我们队列中的所有患者从硼替佐米中受益更多。除了≥71岁的患者。
■ISS可能在≥71岁的患者中失去预后价值。老年患者的预后较差，需要更有效且毒性更低的治疗。多发性骨髓瘤是一种常见于老年人的血癌。为了治疗这种疾病，遗传异常,患者身体状况差和肿瘤细胞丰富是主要困难。我们经常从临床试验中得出这些结论。然而,临床试验总是招募相对年轻的患者，因此，这些因素的存在和意义可能会有所不同，从临床试验到现实世界。我们进行了这项研究，以找出年轻和老年患者的真正风险。我们发现老年患者更容易患贫血,营养状况和肾功能差。我们还发现老年患者复发的风险更大，进展或死亡比年轻患者。身体虚弱是治疗老年患者的主要障碍，肿瘤负担不再影响这些人的预后。硼替佐米是治疗这种疾病的有效药物，但≥71岁的患者比年轻患者获益较少.更多的研究应该集中在老年或虚弱的患者，因为这些患者需要更有效和毒性更低的治疗。
