Hari P, Romanus D, Henk H J, Becker L K, Noga S J, Morrison V A
Medical College of Wisconsin, Milwaukee, WI, USA.
Takeda Pharmaceuticals International Co., Cambridge, MA, USA.
J Clin Pharm Ther. 2018 Feb;43(1):45-51. doi: 10.1111/jcpt.12606. Epub 2017 Aug 17.
Second-line therapy (SLT) trials in relapsed/refractory multiple myeloma (RRMM) report superior outcomes with triplet combinations. We sought to determine factors associated with triplet SLT in routine practice.
A retrospective cohort with claims for MM between 01/01/2008 and 03/31/2015 was grouped by 1-2 ("doublet") or 3+ ("triplet") agent therapy. Charlson comorbidity index (CCI) and disability status; CRAB symptoms (hypercalcaemia, renal/bone disease, anaemia); and relapse risk were determined.
Among 623 patients, the triplet group (n=146 [23%]) was younger (65.2 vs 69.8 years) and more likely to have high-risk relapse (67% vs 50%), CRAB symptoms (94.5% vs 81.1%), triplet first-line treatment (75% vs 51%) and frontline stem cell transplant (38% vs 20%) (P<0.001 for all). In multivariate analyses, CRAB symptoms (OR: 3.22, 95% CI: 1.47, 7.10), high-risk relapse (OR: 1.71, 95% CI: 1.12, 2.62) and prior triplet therapy (OR: 2.16, 95% CI: 1.38, 3.40), but neither CCI nor disability, were associated with triplet SLT. A trend towards triplets among younger patients (<65 vs >75 years, OR: 1.73, 95% CI: 0.99, 3.04) was observed.
The majority of patients did not receive triplet regimens. Treatment selection with triplet therapy for RRMM should carefully consider comorbidities and patient-specific characteristics.
复发/难治性多发性骨髓瘤（RRMM）的二线治疗（SLT）试验表明，三联组合疗法的疗效更佳。我们试图确定在常规临床实践中与三联SLT相关的因素。
对2008年1月1日至2015年3月31日期间患有MM的患者进行回顾性队列研究，根据使用1 - 2种（“双联”）或3种及以上（“三联”）药物治疗进行分组。确定Charlson合并症指数（CCI）和残疾状况、CRAB症状（高钙血症、肾脏/骨骼疾病、贫血）以及复发风险。
在623例患者中，三联组（n = 146 [23%]）患者更年轻（65.2岁对69.8岁），且更有可能具有高风险复发（67%对50%）、CRAB症状（94.5%对81.1%）、接受三联一线治疗（75%对51%）和一线干细胞移植（38%对20%）（所有P<0.001）。在多变量分析中，CRAB症状（OR：3.22，95%CI：1.47，7.10）、高风险复发（OR：1.71，95%CI：1.12，2.62）和先前的三联疗法（OR：2.16，95%CI：1.38，3.40）与三联SLT相关，但CCI和残疾状况均与之无关。在年轻患者（<65岁对>75岁）中观察到使用三联疗法的趋势（OR：1.73，95%CI：0.99，3.）。
大多数患者未接受三联方案。RRMM三联疗法的治疗选择应仔细考虑合并症和患者的特定特征。
