Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO.
Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO.
Clin Lymphoma Myeloma Leuk. 2019 Sep;19(9):e521-e525. doi: 10.1016/j.clml.2019.05.003. Epub 2019 May 13.
Current guidelines recommend that autologous hematopoietic stem cell transplantation (AHSCT) be considered for all eligible patients with multiple myeloma during first-line treatment. However, less than one-third of patients in the United States undergo the procedure. The reasons for this are unclear.
We performed a mixed-methods study including qualitative interviews of patients who declined AHSCT at a high-volume regional transplantation center.
Over a 12-month period, 63% (129/206) of patients underwent AHSCT during first-line therapy. The consulting physician deemed 26% (47) ineligible. An additional 11% (23) were eligible but declined. In the qualitative interviews, 3 themes emerged regarding AHSCT refusal: (1) possible toxicity and disruption in quality of life; (2) unclear gains of AHSCT versus standard chemotherapy; and (3) the sense that transplantation was not suggested for them specifically, rather it was "the routine"; we coined this theme "impersonalized medicine."
On the basis of our findings, we stress the importance of providers helping patients weigh the respective benefits and outcomes of AHSCT and non-AHSCT treatment approaches during the clinical encounter, a key tenet of shared decision-making.
目前的指南建议，在一线治疗中，所有符合条件的多发性骨髓瘤患者都应考虑进行自体造血干细胞移植（AHSCT）。然而，美国只有不到三分之一的患者接受了该手术。其原因尚不清楚。
我们进行了一项混合方法研究，包括在一家高容量的区域移植中心对拒绝 AHSCT 的患者进行定性访谈。
在 12 个月的时间里，63%（129/206）的患者在一线治疗中接受了 AHSCT。咨询医生认为 26%（47）的患者不符合条件。另有 11%（23）的患者符合条件但拒绝了。在定性访谈中，有 3 个主题与 AHSCT 拒绝有关：（1）可能的毒性和生活质量下降；（2）AHSCT 与标准化疗相比的获益不明确；（3）他们觉得移植不是专门为他们建议的，而是“常规”治疗；我们将这一主题称为“非个性化医疗”。
基于我们的发现，我们强调了提供者在临床就诊期间帮助患者权衡 AHSCT 和非 AHSCT 治疗方法的各自益处和结果的重要性，这是共同决策的关键原则。
