Sanchez Larysa, Sylvester Michael, Parrondo Ricardo, Mariotti Veronica, Eloy Jean Anderson, Chang Victor T
Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey.
Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey.
Biol Blood Marrow Transplant. 2017 Jul;23(7):1203-1207. doi: 10.1016/j.bbmt.2017.03.012. Epub 2017 Mar 9.
Autologous hematopoietic stem cell transplantation (auto-HSCT) has improved survival in patients with multiple myeloma (MM) and is increasingly used in elderly patients. The aim of this study was to characterize and compare in-hospital complications and mortality after auto-HSCT in younger (< age 65) versus elderly (> age 65) MM patients utilizing the Nationwide Inpatient Sample. Over a 3-year period (2008 to 2010), 2209 patients with MM were admitted to US hospitals for auto-HSCT. The median age was 59 years, with 1650 patients (74.7%) younger than age 65 and 559 patients (25.3%) 65 or older. Overall, in-hospital mortality in MM patients after auto-HSCT was rare (1.5%) and there was no significant difference in mortality between elderly and younger patients. Elderly patients did have a significantly increased mean length of stay (18.6 days + 10.8 days [SD] versus 16.8 days + 7.2 days [SD], P < .001) and mean total hospital charges ($161,117 + $105,008 [SD] versus $151,192 + $78,342 [SD] , P = .018) compared with younger patients. Elderly patients were significantly more likely than younger patients to develop major in-hospital post-transplantation complications such as severe sepsis (odds ratio [OR], 2.70; 95% confidence interval [CI], 1.40 to 5.21; P = .003), septic shock (OR, 3.10; 95% CI, 1.43 to 6.71; P = .004), pneumonia (OR, 1.62; 95% CI, 1.06 to 2.46; P = .024), acute respiratory failure (OR, 3.44; 95% CI, 1.70 to 6.96; P = .001), endotracheal intubation requiring prolonged mechanical ventilation (OR, 2.19; 95% CI, 1.06 to 4.55; P = .035), acute renal failure (OR, 2.14; 95% CI, 1.38 to 3.33; P = .001), and cardiac arrhythmias (OR, 2.06; 95% CI, 1.52 to 2.79; P <.001). These data may help guide informed consent discussions and provide a focus for future studies to reduce treatment-related morbidity in elderly MM patients undergoing auto-HSCT.
自体造血干细胞移植（auto-HSCT）改善了多发性骨髓瘤（MM）患者的生存率，并且越来越多地应用于老年患者。本研究的目的是利用全国住院患者样本，对年龄较轻（<65岁）与老年（>65岁）MM患者自体造血干细胞移植后的院内并发症及死亡率进行特征描述和比较。在2008年至2010年的3年期间，2209例MM患者因自体造血干细胞移植入住美国医院。中位年龄为59岁，其中1650例患者（74.7%）年龄小于65岁，559例患者（25.3%）年龄在65岁及以上。总体而言，MM患者自体造血干细胞移植后的院内死亡率较低（1.5%），老年患者与年轻患者的死亡率无显著差异。与年轻患者相比，老年患者的平均住院时间显著延长（分别为18.6天±10.8天[标准差]与16.8天±7.2天[标准差]，P<0.001），平均总住院费用也显著更高（分别为161,117美元±105,008美元[标准差]与151,192美元±78,342美元[标准差]，P=0.018）。老年患者比年轻患者更易发生严重的移植后院内并发症，如严重脓毒症（比值比[OR]，2.70；95%置信区间[CI]，1.40至5.21；P=0.003）、感染性休克（OR，3.10；95%CI，1.43至6.71；P=0.004）、肺炎（OR，1.62；95%CI，1.06至2.46；P=0.024）、急性呼吸衰竭（OR，3.44；95%CI，1.70至6.96；P=0.001）、需要长时间机械通气的气管插管（OR，2.19；95%CI，1.06至4.55；P=0.035）、急性肾衰竭（OR，2.14；95%CI，1.38至3.33；P=0.001）以及心律失常（OR，2.06；95%CI，1.52至2.79；P<0.001）。这些数据可能有助于指导知情同意讨论，并为未来研究提供重点，以降低接受自体造血干细胞移植的老年MM患者的治疗相关发病率。
