Gulbrandsen N, Wisløff F, Brinch L, Carlson K, Dahl I M, Gimsing P, Hippe E, Hjorth M, Knudsen L M, Lamvik J, Lenhoff S, Løfvenberg E, Nesthus I, Nielsen J L, Turesson I, Westin J
Department of Hematology, Ullevål University Hospital, Oslo, Norway.
Med Oncol. 2001;18(1):65-77. doi: 10.1385/MO:18:1:65.
In a population-based study, the Nordic Myeloma Study Group found a survival advantage for high-dose melphalan with autologous blood stem-cell support compared to conventional chemotherapy in myeloma patients under 60 yr of age (risk ratio: 1.62; confidence interval [CI] 1.22-2.15; p = 0.001). A study of health-related quality of life (HRQoL) was integrated in the trial, using the EORTC QLQ-C30 questionnaire. Of the 274 patients receiving intensive therapy 221 (81%) were compared to 113 (94%) of 120 patients receiving conventional melphalan-prednisone treatment. Prior to treatment, there were no statistically significant differences in any HRQoL score between the two groups. One month after the start of induction chemotherapy, the patients on intensive treatment had more sleep disturbance than the control patients. At 6 mo, corresponding to a mean of 52 d after high-dose melphalan, the patients on intensive treatment had moderately lower scores for global QoL and role and social functioning and there was also a significantly higher score for appetite loss. At 12 and 24 mo, the HRQoL was similar to that of the control patients. At 36 mo, there was a trend toward less fatigue, pain, nausea, and appetite loss in the intensive-treatment group. Thus, the 18 mo of prolonged survival seem to be associated with a good health-related quality of life. Despite the moderate HRQoL reduction associated with the early intensive chemotherapy phase, this treatment modality must be regarded as an important step forward in the care of multiple myeloma.
在一项基于人群的研究中，北欧骨髓瘤研究组发现，对于60岁以下的骨髓瘤患者，与传统化疗相比，高剂量美法仑联合自体血干细胞支持治疗具有生存优势（风险比：1.62；置信区间[CI]1.22 - 2.15；p = 0.001）。一项关于健康相关生活质量（HRQoL）的研究被纳入该试验，采用欧洲癌症研究与治疗组织（EORTC）的QLQ - C30问卷。在接受强化治疗的274例患者中，221例（81%）与接受传统美法仑 - 泼尼松治疗的120例患者中的113例（94%）进行了比较。治疗前，两组之间的任何HRQoL评分均无统计学显著差异。诱导化疗开始后1个月，强化治疗组的患者比对照组患者有更多的睡眠障碍。在6个月时，相当于高剂量美法仑治疗后平均52天，强化治疗组患者的总体生活质量、角色功能和社会功能得分略低，食欲减退得分也显著更高。在12个月和24个月时，HRQoL与对照组患者相似。在36个月时，强化治疗组有疲劳、疼痛、恶心和食欲减退减轻的趋势。因此，延长的18个月生存期似乎与良好的健康相关生活质量相关。尽管早期强化化疗阶段会使HRQoL适度降低，但这种治疗方式必须被视为多发性骨髓瘤治疗向前迈出的重要一步。
