Chen H M, Zhou F, Wei W, Peng R, Shi H T, Hou J
Department of Hematology, Changzheng Hospital, The Second Military Medical Uuniversity, Shanghai 200003, China.
Zhonghua Xue Ye Xue Za Zhi. 2017 Sep 14;38(9):744-748. doi: 10.3760/cma.j.issn.0253-2727.2017.09.003.
To explore the clinical features and prognostic factors of elderly MM patients. A retrospectively analysis of clinical characteristics in 93 newly diagnosed MM patients with more than 70 years of old between August 2011 and August 2016. Based on age, basic activities of daily living scale, instrumental activities of daily living scale, Charlson comorbidity index at diagnosis, patients were divided into three groups: Fit (score=0, =15) , Intermediate fitness (score=1, =31) , Frail (score≥2, =47) according to a geriatric assessment system proposed by Antonio Palumbo et al. The treatment response rate, progression free survival time (PFS) and overall survival (OS) of the three groups were analyzed. Complete remission was 60.0% in Fit, 22.6% in Intermediate fitness and 12.8% in Frail (Fisher (2)=12.398, =0.002) . The median PFS for the three groups were 31 months, 24 months and 13 months ((2)=17.832, <0.001) . The median OS was not reached for Fit, 58 months for Intermediate fitness and 25 months for Frail ((2)=40.678, <0.001) . In 47 Frail cases, patients who received chemotherapy containing new drugs (proteasome inhibitor or immune-modulator) had a longer PFS (17 months 9 months, (2)=6.454, =0.011) and patients who achieved CR had prolonged PFS and OS than non-CR (PFS: 24 months 12 months, (2)=4.117, =0.042; OS: 37 months 25 months, (2)= 6.507, =0.011) . The health status of the elderly MM patients was associated with better response and longer PFS and OS. Given on those with poor health status, new drugs may have better PFS and prolonged OS.
为探讨老年多发性骨髓瘤（MM）患者的临床特征及预后因素。对2011年8月至2016年8月期间93例年龄大于70岁的新诊断MM患者的临床特征进行回顾性分析。根据年龄、日常生活基本活动量表、日常生活工具性活动量表、诊断时的Charlson合并症指数，按照Antonio Palumbo等人提出的老年评估系统，将患者分为三组：健康组（评分=0，=15）、中等健康组（评分=1，=31）、虚弱组（评分≥2，=47）。分析三组的治疗缓解率、无进展生存期（PFS）和总生存期（OS）。健康组的完全缓解率为60.0%，中等健康组为22.6%，虚弱组为12.8%（Fisher(2)=12.398，=0.002）。三组的中位PFS分别为31个月、24个月和13个月（(2)=17.832，<0.001）。健康组的中位OS未达到，中等健康组为58个月，虚弱组为25个月（(2)=40.678，<0.001）。在47例虚弱患者中，接受含新药（蛋白酶体抑制剂或免疫调节剂）化疗的患者PFS更长（17个月对9个月，(2)=6.454，=0.011），达到完全缓解（CR）的患者比未达到CR的患者PFS和OS更长（PFS：24个月对12个月，(2)=4.117，=0.042；OS：37个月对25个月，(2)=6.507，=0.011）。老年MM患者的健康状况与更好的缓解、更长的PFS和OS相关。对于健康状况较差的患者，新药可能有更好的PFS和更长的OS。
