老年评估可预测老年骨髓瘤患者的生存率和毒性：国际骨髓瘤工作组报告
Geriatric assessment predicts survival and toxicities in elderly myeloma patients: an International Myeloma Working Group report.
作者信息
Palumbo Antonio, Bringhen Sara, Mateos Maria-Victoria, Larocca Alessandra, Facon Thierry, Kumar Shaji K, Offidani Massimo, McCarthy Philip, Evangelista Andrea, Lonial Sagar, Zweegman Sonja, Musto Pellegrino, Terpos Evangelos, Belch Andrew, Hajek Roman, Ludwig Heinz, Stewart A Keith, Moreau Philippe, Anderson Kenneth, Einsele Hermann, Durie Brian G M, Dimopoulos Meletios A, Landgren Ola, San Miguel Jesus F, Richardson Paul, Sonneveld Pieter, Rajkumar S Vincent
机构信息
Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy;
Servicio de Hematología, Hospital Universitario de Salamanca, Centro de Investigación del Cáncer, Instituto de Biología Molecular y Celular del Cáncer, Universidad de Salamanca-Centro Superior de Investigaciones Científicas, Salamanca, Spain;
出版信息
Blood. 2015 Mar 26;125(13):2068-74. doi: 10.1182/blood-2014-12-615187. Epub 2015 Jan 27.
We conducted a pooled analysis of 869 individual newly diagnosed elderly patient data from 3 prospective trials. At diagnosis, a geriatric assessment had been performed. An additive scoring system (range 0-5), based on age, comorbidities, and cognitive and physical conditions, was developed to identify 3 groups: fit (score = 0, 39%), intermediate fitness (score = 1, 31%), and frail (score ≥2, 30%). The 3-year overall survival was 84% in fit, 76% in intermediate-fitness (hazard ratio [HR], 1.61; P = .042), and 57% in frail (HR, 3.57; P < .001) patients. The cumulative incidence of grade ≥3 nonhematologic adverse events at 12 months was 22.2% in fit, 26.4% in intermediate-fitness (HR, 1.23; P = .217), and 34.0% in frail (HR, 1.74; P < .001) patients. The cumulative incidence of treatment discontinuation at 12 months was 16.5% in fit, 20.8% in intermediate-fitness (HR, 1.41; P = .052), and 31.2% in frail (HR, 2.21; P < .001) patients. Our frailty score predicts mortality and the risk of toxicity in elderly myeloma patients. The International Myeloma Working group proposes this score for the measurement of frailty in designing future clinical trials. These trials are registered at www.clinicaltrials.gov as #NCT01093136 (EMN01), #NCT01190787 (26866138MMY2069), and #NCT01346787 (IST-CAR-506).
我们对来自3项前瞻性试验的869例新诊断老年患者的个体数据进行了汇总分析。在诊断时，进行了老年综合评估。基于年龄、合并症以及认知和身体状况，开发了一种加法评分系统（范围0 - 5），以识别3组患者：健康组（评分 = 0，39%）、中等健康组（评分 = 1，31%）和虚弱组（评分≥2，30%）。健康组患者的3年总生存率为84%，中等健康组为76%（风险比[HR]，1.61；P = 0.042），虚弱组为57%（HR，3.57；P < 0.001）。12个月时≥3级非血液学不良事件的累积发生率在健康组为22.2%，中等健康组为26.4%（HR，1.23；P = 0.217），虚弱组为34.0%（HR，1.74；P < 0.001）。12个月时治疗中断的累积发生率在健康组为16.5%，中等健康组为20.8%（HR，1.41；P = 0.052），虚弱组为31.2%（HR，2.21；P < 0.001）。我们的虚弱评分可预测老年骨髓瘤患者的死亡率和毒性风险。国际骨髓瘤工作组建议在设计未来临床试验时使用该评分来衡量虚弱程度。这些试验已在www.clinicaltrials.gov上注册，注册号分别为#NCT01093136（EMN01）、#NCT01190787（26866138MMY2069）和#NCT01346787（IST - CAR - 506）。
Zotero 插件