Oortgiesen B E, van Roon E N, Joosten P, Kibbelaar R E, Storm H, Hovenga S, van Rees B, Woolthuis G, Veeger N, de Waal E G, Hoogendoorn M
Department of Clinical Pharmacy & Pharmacology, Medical Centre Leeuwarden, Leeuwarden, PO Box 888, 8901 BR Leeuwarden, The Netherlands.
Unit of Pharmacotherapy, Epidemiology and Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
Eur J Clin Pharmacol. 2017 Jun;73(6):771-778. doi: 10.1007/s00228-017-2227-1. Epub 2017 Mar 3.
This prospective, observational population-based cohort study was performed to determine overall survival (OS) in multiple myeloma (MM) patients in Friesland, the Netherlands, in the era of novel agents and to analyse the influence of first-line treatment, MM-related end-organ damage and comorbidities at initial presentation on OS.
Detailed clinical information was obtained from the population-based registry 'HemoBase' during the period January 2005 to January 2013, with a follow-up to January 2014.
Overall, the symptomatic MM patients (n = 225) had a median OS of 40 months. In the age categories <65, 65-75 and ≥75 years, 99, 94 and 87% of the patients received treatment, with a median OS of 92, 42 and 31 months, respectively. OS for patients with or without treatment was 43 and 3 months, respectively. In multivariable analysis, risk factors for worse OS were increasing age (<65: reference; 65-75: HR = 2.2 (95% CI 1.3-3.7) and ≥75: HR = 2.8 (95% CI 1.7-4.8); P < 0.001), not receiving initial treatment (HR = 4.0 (95% CI 2.1-7.7); P < 0.001), hypercalcaemia (P < 0.001, HR = 1.7 (95% CI 1.2-2.6), P = 0.006) and impaired renal function (HR = 2.6 (95% CI 1.7-4.0); P < 0.001).
Increasing age, not receiving initial treatment, hypercalcaemia and impaired renal function at initial presentation were independent risk factors for worse OS. Comorbidity according to Charlson comorbidity index score was not an independent variable predicting OS.
本前瞻性、基于人群的观察性队列研究旨在确定荷兰弗里斯兰省在新型药物时代多发性骨髓瘤（MM）患者的总生存期（OS），并分析一线治疗、MM相关终末器官损害和初始就诊时的合并症对总生存期的影响。
在2005年1月至2013年1月期间，从基于人群的登记处“HemoBase”获取详细的临床信息，并随访至2014年1月。
总体而言，有症状的MM患者（n = 225）的中位总生存期为40个月。在年龄<65岁、65 - 75岁和≥75岁的类别中，分别有99%、94%和87%的患者接受了治疗，中位总生存期分别为92个月、42个月和31个月。接受治疗和未接受治疗的患者的总生存期分别为43个月和3个月。在多变量分析中，总生存期较差的危险因素包括年龄增加（<65岁：参照；65 - 75岁：HR = 2.2（95% CI 1.3 - 3.7），≥75岁：HR = 2.8（95% CI 1.7 - 4.8）；P < 0.001）、未接受初始治疗（HR = 4.0（95% CI 2.1 - 7.7）；P < 0.001）、高钙血症（P < 0.001，HR = 1.7（95% CI 1.2 - 2.6），P = 0.006）和肾功能受损（HR = 2.6（95% CI 1.7 - 4.0）；P < 0.001）。
年龄增加、未接受初始治疗、初始就诊时高钙血症和肾功能受损是总生存期较差的独立危险因素。根据Charlson合并症指数评分的合并症不是预测总生存期的独立变量。
