Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Br J Haematol. 2018 Aug;182(4):513-520. doi: 10.1111/bjh.15426. Epub 2018 Jul 5.
The management of multiple myeloma (MM) has evolved with the increased use of autologous haematopoietic cell transplantation (AHCT) and the introduction of new agents. AHCT and lenalidomide maintenance have been associated with increased risk of second primary malignancy (SPM). We iseutilised the Surveillance, Epidemiology and End Results 13 registries to analyse 9 833 patients diagnosed at age <65 years for three eras: 1995-99 (pre-thalidomide, limited use of AHCT), 2000-04 (post-thalidomide, pre-lenalidomide and bortezomib, increased isautilisation of AHCT) and 2005-09 (post-lenalidomide and bortezomib, higher isautilisation of AHCT). Changes in risk of SPM were assessed by utilising standardised incidence ratio (SIR) and cause-specific risk of death. Cumulative incidence of SPM at 90 months was 4·7%, 6·0% and 6·3% respectively, P = 0·0008. SIR for haematological malignancies in years 1-5 increased, from 1·28 (95% confidence interval [CI] 0·47-2·78) in 1995-99 to 2·17 (95% CI: 1·27-3·48) in 2005-09, due to increased risk of acute leukaemias and lymphomas. A similar trend was observed in years 6-10. Overall mortality in patients with MM declined sharply over time due to declines in MM-associated and cardiovascular mortality with no increase in risk of death from SPM. The evolution of MM therapy is linked to population-level increase in risk with no discernible effect in death from SPM.
多发性骨髓瘤（MM）的治疗方法随着自体造血细胞移植（AHCT）的广泛应用和新药物的引入而不断发展。AHCT 和来那度胺维持治疗与第二原发恶性肿瘤（SPM）风险增加相关。我们利用监测、流行病学和最终结果 13 个登记处，分析了年龄<65 岁的 9833 例患者在三个时期的情况：1995-99 年（沙利度胺前，AHCT 应用有限）、2000-04 年（沙利度胺后，来那度胺和硼替佐米前，AHCT 应用增加）和 2005-09 年（来那度胺和硼替佐米后，AHCT 应用更多）。利用标准化发病比（SIR）和特定原因死亡风险评估 SPM 风险的变化。90 个月时 SPM 的累积发生率分别为 4.7%、6.0%和 6.3%，P=0.0008。1-5 年内血液系统恶性肿瘤的 SIR 增加，从 1995-99 年的 1.28（95%可信区间[CI]0.47-2.78）增加到 2005-09 年的 2.17（95% CI：1.27-3.48），这是由于急性白血病和淋巴瘤的风险增加。在 6-10 年内也观察到类似的趋势。由于 MM 相关和心血管死亡率下降，MM 患者的总死亡率随着时间的推移急剧下降，而 SPM 导致的死亡风险没有增加。MM 治疗方法的发展与人群中风险的增加有关，而 SPM 导致的死亡风险没有明显变化。
