Division of Hematology, Mayo Clinic, Rochester, MN, USA.
Division of Nephrology, Mayo Clinic, Rochester, MN, USA.
Leukemia. 2014 May;28(5):1122-8. doi: 10.1038/leu.2013.313. Epub 2013 Oct 25.
Therapy for multiple myeloma (MM) has markedly changed in the past decade with the introduction of new drugs, but it is not clear whether the improvements have been sustained. We studied 1038 patients diagnosed between 2001 and 2010, grouping patients into two 5-year periods by diagnosis, 2001-2005 and 2006-2010. The median estimated follow-up for the cohort was 5.9 years with 47% alive at the last follow-up. The median overall survival (OS) for the entire cohort was 5.2 years: 4.6 years for patients in the 2001-2005 group compared with 6.1 years for the 2006-2010 cohort (P=0.002). The improvement was primarily seen among patients over 65 years, the 6-year OS improving from 31 to 56%, P<0.001. Only 10% of patients died during the first year in the latter group, compared with 16% in the earlier cohort (P<0.01), suggesting improvement in early mortality. The improved outcomes were linked closely to the use of one or more new agents in initial therapy. The current results confirm continued survival improvement in MM and highlight the impact of initial therapy with novel agents. Most importantly, we demonstrate that the improved survival is benefitting older patients and that early mortality in this disease has reduced considerably.
多发性骨髓瘤（MM）的治疗在过去十年中发生了显著变化，新药物的引入是主要原因，但目前尚不清楚这些改善是否持续存在。我们研究了 1038 例 2001 年至 2010 年间诊断的患者，根据诊断时间将患者分为两个 5 年组，即 2001-2005 年和 2006-2010 年。该队列的中位估计随访时间为 5.9 年，最后一次随访时仍有 47%的患者存活。整个队列的中位总生存期（OS）为 5.2 年：2001-2005 组的患者为 4.6 年，而 2006-2010 组为 6.1 年（P=0.002）。这种改善主要发生在 65 岁以上的患者中，6 年 OS 从 31%提高到 56%，P<0.001。在后一组中，只有 10%的患者在第一年死亡，而前一组为 16%（P<0.01），这表明早期死亡率有所降低。这些改善的结果与初始治疗中使用一种或多种新型药物密切相关。目前的结果证实了 MM 持续生存改善，并强调了新型药物初始治疗的影响。最重要的是，我们证明了改善的生存使老年患者受益，而且这种疾病的早期死亡率已大大降低。
