Chen Ying, Lairson David R, Chan Wenyaw, Du Xianglin L
Department of Epidemiology, Human Genetics, and Environmental Science, School of Public Health, University of Texas Health Science Center in Houston, 1200 Pressler Street, RAS-E631, Houston, TX, 77030, USA.
Department of Management Policy and Community Health, School of Public Health, University of Texas Health Science Center in Houston, Houston, TX, USA.
Ann Hematol. 2018 May;97(5):851-863. doi: 10.1007/s00277-018-3238-4. Epub 2018 Jan 15.
This study aims to examine the risks of adverse events associated with anti-multiple myeloma (MM) therapies in a large population-based cohort of elderly patients with MM. Patients diagnosed with advanced MM from 2005 through 2009 and receiving anti-MM therapy were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked data. We compared safety outcomes between novel agents (proteasome inhibitor (PI) and immunomodulatory drugs (IMiD)) and other therapies and between PI- or IMiD-based regimens and PI plus IMiD combination regimens. Of 2587 patients with advanced MM, 2048 (79%) received novel agents and 539 (21%) received other therapies. Patients with preexisting anemia and thrombocytopenia were significantly more likely to receive novel agents (85.9 vs. 82.4%, P = 0.038; 13.8 vs. 10.4%, P = 0.036), while those with preexisting cardiovascular disease and hypertension were significantly less likely to receive novel agents (73.4 vs. 79.8%, P = 0.003; 81.3 vs. 85.2%, P = 0.035). The hazard ratios for anemia, peripheral neuropathy, and thromboembolic events for patients receiving novel agents compared with those receiving other therapies were 1.19 (95% CI, 1.06-1.32), 1.57 (95% CI, 1.15-2.15), and 1.31 (95% CI, 1.03-1.67). The hazard ratios for anemia, neutropenia, and thromboembolic events for patients receiving PI plus IMiD combination therapies compared with those receiving PI- or IMiD-based therapies were 1.31 (95% CI, 1.12-1.54), 1.66 (95% CI, 1.27-2.18, and 1.37 (95% CI, 1.02-1.86). Novel agents significantly increased the risk of anemia, peripheral neuropathy, and thromboembolic events. PI plus IMiD combination therapies were associated with significantly higher risk for anemia, neutropenia, and thromboembolic events.
本研究旨在调查一大群老年多发性骨髓瘤（MM）患者中与抗MM治疗相关的不良事件风险。从监测、流行病学和最终结果（SEER）-医疗保险关联数据中识别出2005年至2009年诊断为晚期MM并接受抗MM治疗的患者。我们比较了新型药物（蛋白酶体抑制剂（PI）和免疫调节药物（IMiD））与其他疗法之间以及基于PI或IMiD的方案与PI加IMiD联合方案之间的安全性结果。在2587例晚期MM患者中，2048例（79%）接受了新型药物治疗，539例（21%）接受了其他疗法。既往有贫血和血小板减少症的患者接受新型药物治疗的可能性显著更高（85.9%对82.4%，P = 0.038；13.8%对10.4%，P = 0.036），而既往有心血管疾病和高血压的患者接受新型药物治疗的可能性显著更低（73.4%对79.8%，P = 0.003；81.3%对85.2%，P = 0.035）。与接受其他疗法的患者相比，接受新型药物治疗的患者发生贫血、周围神经病变和血栓栓塞事件的风险比分别为1.19（95%CI，1.06 - 1.32）、1.57（95%CI，1.15 - 2.15）和1.31（95%CI，1.03 - 1.67）。与接受基于PI或IMiD的疗法的患者相比，接受PI加IMiD联合疗法的患者发生贫血、中性粒细胞减少症和血栓栓塞事件的风险比分别为1.31（95%CI，1.12 - 1.54）、1.66（95%CI，1.27 - 2.18）和1.37（95%CI，1.02 - 1.86）。新型药物显著增加了贫血、周围神经病变和血栓栓塞事件的风险。PI加IMiD联合疗法与贫血、中性粒细胞减少症和血栓栓塞事件的风险显著更高相关。
