Clinica di Ematologia Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy.
Clin Lymphoma Myeloma Leuk. 2012 Dec;12(6):423-32. doi: 10.1016/j.clml.2012.06.008. Epub 2012 Sep 14.
Multiple myeloma (MM) therapy should be tailored according to patient characteristics although we do not know which ones to use. By studying the characteristics of 266 real-life patients, we found performance status (PS) and Charlson Comorbidity Index (CCI) as factors affecting survival of MM patients regardless of their disease characteristics. This study might help to select patients for tailoring therapy in clinical practice.
Multiple myeloma is a typical disease of the elderly but how many and which patients can be considered 'vulnerable' and how this may affect patient outcome remain unsolved issues.
Data from 266 symptomatic MM patients registered at Marche MM registry from 2007 to 2010 were evaluated retrospectively. Vulnerability was defined as age > 75 years, PS (World Health Organization) ≥ 2, renal insufficiency (RI), bone fracture, cytopenias, and CCI score ≥ 1. Kaplan-Meier method and Cox regression were used to assess survival and associated factors. A vulnerability score (VS) incorporating significant vulnerability features was pursued to predict survival.
Thirty-eight percent of patients were older than 75 years, 39% had PS = 2-4, 35% had at least 2 cytopenias, 40% had bone fracture, 14% RI, and 51% had CCI score ≥ 1. Cox regression selected international staging system (ISS) = III (hazard ratio [HR] = 1.6; P = .033), PS = 2-4 (HR = 2.5; P = .007), and CCI = 1-3 (HR = 2.1; P = .028) as factors associated with a worse overall survival. A VS including PS and CCI predicted median survival of 27 months in the 63 patients having a VS = 2 (both PS = 2-4 and CCI = 1-3) versus not reached (NR) in the 203 patients with VS = 0-1 (HR = 4.0; P < .0001). In younger patients multivariate analysis selected ISS = III (HR = 5.2; P = .006) and VS = 2 (HR = 5.5; P = .024) as factors associated with shorter survival whereas only VS = 2 (HR = 3.5; P = .002) affected worse survival in elderly.
Such VS proved to be a powerful prognostic factor for survival of MM patients and it might be useful to identify true vulnerable patients regardless of age.
多发性骨髓瘤（MM）是一种典型的老年疾病，但有多少以及哪些患者可以被认为是“脆弱”的，以及这如何影响患者的预后仍然是悬而未决的问题。
回顾性分析了 2007 年至 2010 年在马尔凯 MM 注册中心登记的 266 例有症状 MM 患者的数据。脆弱性定义为年龄>75 岁、PS（世界卫生组织）≥2、肾功能不全（RI）、骨折、细胞减少症和 CCI 评分≥1。采用 Kaplan-Meier 法和 Cox 回归分析评估生存和相关因素。采用包含显著脆弱特征的脆弱性评分（VS）来预测生存。
38%的患者年龄大于 75 岁，39%的患者 PS=2-4，35%的患者至少有 2 种细胞减少症，40%的患者有骨折，14%的患者 RI，51%的患者 CCI 评分≥1。Cox 回归选择国际分期系统（ISS）=III（危险比[HR]为 1.6；P=0.033）、PS=2-4（HR 为 2.5；P=0.007）和 CCI=1-3（HR 为 2.1；P=0.028）作为与总体生存较差相关的因素。在有 VS=2（PS=2-4 和 CCI=1-3）的 63 例患者中，包含 PS 和 CCI 的 VS 预测中位生存时间为 27 个月，而 VS=0-1 的 203 例患者中位生存时间未达到（NR）（HR=4.0；P<0.0001）。在年轻患者中，多变量分析选择 ISS=III（HR=5.2；P=0.006）和 VS=2（HR=5.5；P=0.024）作为与较短生存相关的因素，而仅 VS=2（HR=3.5；P=0.002）影响老年患者的生存较差。
这种 VS 被证明是 MM 患者生存的一个强有力的预后因素，它可能有助于识别真正脆弱的患者，而与年龄无关。
