Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Department of Internal Medicine, Attikon Hospital, Haidari, Greece.
Eur J Haematol. 2017 Nov;99(5):409-414. doi: 10.1111/ejh.12923. Epub 2017 Sep 26.
To evaluate the prognostic impact of hypercalcemia in newly diagnosed patients with symptomatic multiple myeloma (MM), especially after the incorporation of new agents.
we analyzed the outcomes of newly diagnosed patients with symptomatic myeloma included in the database of the Greek Myeloma Study Group for the prognostic effect of the presence of hypercalcemia (defined as corrected serum calcium ≥11 mg/dL) at diagnosis.
Among 2129 consecutive patients with symptomatic MM, 19.5% presented with hypercalcemia at the time of diagnosis. The presence of hypercalcemia was associated with anemia, thrombocytopenia, lower estimated glomerular filtration rate (eGFR), advanced ISS stage, and presence of lytic lesions. Hypercalcemia was more common in patients with high-risk cytogenetics and was associated with inferior survival across different time periods, age groups, and primary treatments. Hypercalcemia was also associated with a twofold increase in the risk of early death. In patients without available FISH, hypercalcemia could substitute for the presence of high-risk cytogenetics and identify patients with worse prognosis along with ISS stage and elevated serum LDH.
Hypercalcemia remains a poor prognostic feature in the era of novel agents despite the improvement in the outcomes of patients who present with elevated calcium.
评估新诊断的有症状多发性骨髓瘤（MM）患者高钙血症的预后影响，特别是在加入新药物后。
我们分析了希腊骨髓瘤研究组数据库中纳入的新诊断为有症状骨髓瘤患者的结局，以评估高钙血症（定义为校正血清钙≥11mg/dL）在诊断时的存在对预后的影响。
在 2129 例连续的有症状 MM 患者中，19.5%在诊断时出现高钙血症。高钙血症与贫血、血小板减少、肾小球滤过率（eGFR）估计值较低、ISS 晚期和溶骨性病变有关。高钙血症在具有高危细胞遗传学的患者中更为常见，并且与不同时间段、年龄组和主要治疗的生存预后较差有关。高钙血症还与早期死亡风险增加两倍相关。在没有可用 FISH 的患者中，高钙血症可以替代高危细胞遗传学，并与 ISS 分期和升高的血清 LDH 一起识别预后较差的患者。
尽管接受高钙血症治疗的患者的结局得到了改善，但高钙血症在新型药物时代仍然是一个不良预后因素。
