Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
Clinica di Ematologia, AOU Ospedali Riuniti di Ancona, Ancona, Italy.
Crit Rev Oncol Hematol. 2018 Oct;130:27-35. doi: 10.1016/j.critrevonc.2018.07.003. Epub 2018 Jul 18.
Early toxic death (≤60 days of diagnosis) in elderly multiple myeloma (MM) patients is attributable to active disease, age and co-morbidities. Rate of early toxic deaths is 10% with conventional chemotherapy mainly due to infection and renal failure. Novel agents have improved MM outcome at the expense of newer toxicity.
We analyzed 1146 individual patient data to assess toxic deaths during induction treatment with first-generation novel agents thalidomide, lenalidomide, bortezomib.
During first-line therapy, 119/1146 patients (10%) died for any cause, and 47/1146 (4%) due to toxicity, including 12/1146 (1%) early deaths. The 24-month cumulative incidence was 4.1% without any difference between bortezomib (18/503 patients, 4%) and lenalidomide (29/643patients, 5%; p = 0.31). Toxic deaths occurred in 34/1039 (3%) patients <80 years and 13/107 (12%) patients ≥80 years. Causes were cardiac events (28%), infections (26%) and vascular complications (15%). In a multivariate analysis, older age and unfavorable ISS stage increased the risk of death.
First-generation novel agents significantly reduced toxic deaths compared to conventional chemotherapy. One third of deaths during first-line therapy were due to cumulative drug-related toxicities, thus supportive approaches and prevention strategies should be optimized. The higher mortality rate for toxicity in octogenarians confirms the need for a careful frailty assessment.
老年多发性骨髓瘤（MM）患者早期因毒性死亡（≤60 天）的原因是疾病活动、年龄和合并症。由于感染和肾衰竭，传统化疗的早期毒性死亡率为 10%。新型药物提高了 MM 的治疗效果，但也增加了新的毒性。
我们分析了 1146 例患者的个体数据，以评估第一代新型药物沙利度胺、来那度胺和硼替佐米诱导治疗期间的毒性死亡。
在一线治疗期间，119/1146 例（10%）患者因任何原因死亡，47/1146 例（4%）患者因毒性死亡，包括 12/1146 例（1%）早期死亡。24 个月的累积发病率为 4.1%，硼替佐米（503 例患者中有 18 例，4%）和来那度胺（643 例患者中有 29 例，5%；p=0.31）之间无差异。毒性死亡发生在 34/1039 例（3%）<80 岁和 13/107 例（12%）≥80 岁患者中。死亡原因是心脏事件（28%）、感染（26%）和血管并发症（15%）。多变量分析显示，年龄较大和不良 ISS 分期增加了死亡风险。
与传统化疗相比，第一代新型药物显著降低了毒性死亡率。一线治疗期间三分之一的死亡是由于累积药物相关毒性，因此应优化支持性方法和预防策略。八十岁以上患者因毒性死亡的比例较高，证实了需要进行仔细的虚弱评估。
