背景:鉴于多发性骨髓瘤(MM)幸存者的生存率提高,我们试图评估他们与普通人群相比继发恶性肿瘤的风险.
方法:这项全国性的基于人群的病例对照队列研究利用了韩国国家健康保险服务(KNHIS)数据库,其中包含2009年至2020年的数据。我们分析了病例队列中诊断为MM的7348例患者。我们从没有MM的普通人群中选择了29,351个人的对照组,采用1:4倾向得分匹配方法。匹配标准包括年龄、性别,和合并症,以确保平衡和可靠的比较。
结果:病例队列中任何继发性恶性肿瘤的累积发生率均显着高于对照组(危险比[HR]1.576,95%置信区间[CI],[1.381-1.798]).病例队列中恶性血液病风险明显较高(HR8.026,95%CI,[5.402-11.924]),尤其是治疗相关性髓系肿瘤(t-MN)(HR12.063,95%CI,[6.839-21.278])。非血液系统恶性肿瘤的发生率没有显着差异。在亚组分析中,符合移植条件的MM患者的任何继发性恶性肿瘤发生率(HR1.104,95%CI,[1.003-1.214])明显高于不符合移植条件的患者.与来那度胺时代相比,来那度胺可用时代的MM患者继发性恶性肿瘤的发生率并未显着增加。
结论:虽然血液系统恶性肿瘤,特别是t-MN,与一般人群相比,MM患者显著升高,非血液系统恶性肿瘤似乎没有显著升高.
BACKGROUND: In light of improved survival rates among multiple myeloma (MM) survivors, we sought to assess their risk of secondary malignancies compared to the general population.
METHODS: This nationwide population-based
case-control cohort study utilized the Korea National Health Insurance Service (KNHIS) database incorporating data from 2009 to 2020. We analyzed a total of 7348 patients diagnosed with MM in the
case cohort. We selected a control group of 29,351 individuals from the general population without MM, employing a 1:4 propensity score matching approach. Matching criteria included age, sex, and comorbidities to ensure a balanced and reliable comparison.
RESULTS: The cumulative incidence of any secondary malignancy was significantly higher in the
case cohort than the control cohort (Hazard ratio [HR] 1.576, 95% confidence interval [CI], [1.381-1.798]). Hematologic malignancy risk was notably higher in the
case cohort (HR 8.026, 95% CI, [5.402-11.924]), especially therapy-related myeloid neoplasms (t-MN) (HR 12.063, 95% CI, [6.839-21.278]). No significant difference was shown in nonhematologic malignancy incidence. In subgroup analysis, transplant-eligible MM patients had a significantly higher incidence of any secondary malignancy (HR 1.104, 95% CI, [1.003-1.214]) than transplant-ineligible patients. The incidence of secondary malignancy in MM patients in the lenalidomide-available era was not significantly increased compared to the prelenalidomide era.
CONCLUSIONS: While hematologic malignancies, particularly t-MN, are significantly elevated in MM patients compared to general population, nonhematologic malignancies do not appear to be significantly elevated.