Lenhoff Stig, Hjorth Martin, Westin Jan, Brinch Lorentz, Bäckström Bengt, Carlson Kristina, Christiansen Ilse, Dahl Inger Marie, Gimsing Peter, Hammerström Jens, Johnsen Hans E, Juliusson Gunnar, Linder Olle, Mellqvist Ulf-Henrik, Nesthus Ingerid, Nielsen Johan Lanng, Tangen Jon Magnus, Turesson Ingemar
Lund University Hospital, Lund, Sweden.
Br J Haematol. 2006 May;133(4):389-96. doi: 10.1111/j.1365-2141.2006.06042.x.
The value of intensive therapy, including autologous stem cell transplantation, in newly diagnosed myeloma patients >60 years is not clear. We evaluated the impact of age (<60 years vs. 60-64 years) on survival in a prospective, population-based setting and compared survival with conventionally treated historic controls. The prospective population comprised 452 patients registered between 1998 and 2000. Of these, 414 received intensive therapy. The historic population, derived from our most recent population-based study on conventional therapy, comprised 281 patients. Of these, 243 fulfilled our eligibility criteria for intensive therapy. For patients undergoing intensive therapy it was found that two factors, beta-2-microglobulin and age <60 years vs. 60-64 years, had independent prognostic impact on survival. However, compared with the historic controls a survival advantage was found both for patients <60 (median 66 months vs. 43 months, P < 0.001) and 60-64 years (median 50 months vs. 27 months; P = 0.001). We conclude that in a population-based setting higher age adversely influences outcome after intensive therapy. Our results indicate that intensive therapy prolongs survival also at age 60-64 years but with less superiority than in younger patients.
强化治疗，包括自体干细胞移植，对60岁以上新诊断的骨髓瘤患者的价值尚不清楚。我们在一项基于人群的前瞻性研究中评估了年龄（<60岁与60 - 64岁）对生存的影响，并将生存率与接受传统治疗的历史对照进行比较。前瞻性人群包括1998年至2000年登记的452名患者。其中，414名接受了强化治疗。历史人群来自我们最近一项关于传统治疗的基于人群的研究，包括281名患者。其中，243名符合我们强化治疗的纳入标准。对于接受强化治疗的患者，发现β2-微球蛋白和年龄<60岁与60 - 64岁这两个因素对生存有独立的预后影响。然而，与历史对照相比，<60岁（中位生存期66个月对43个月，P < 0.001）和60 - 64岁（中位生存期50个月对27个月；P = 0.001）的患者均具有生存优势。我们得出结论，在基于人群的研究中，较高年龄对强化治疗后的结果有不利影响。我们的结果表明，强化治疗在60 - 64岁时也能延长生存期，但优势不如年轻患者明显。
