Fiala Mark A, Foley Nicole C, Zweegman Sonja, Vij Ravi, Wildes Tanya M
Division of Oncology, Section of Bone Marrow Transplant & Leukemia, Washington University School of Medicine, Saint Louis, MO, United States of America.
Division of Oncology, Section of Bone Marrow Transplant & Leukemia, Washington University School of Medicine, Saint Louis, MO, United States of America.
J Geriatr Oncol. 2020 Nov;11(8):1274-1278. doi: 10.1016/j.jgo.2020.03.005. Epub 2020 Mar 10.
Tremendous progress has been made in the treatment of multiple myeloma; however, the majority of this success has been demonstrated in younger patients. With 36% of patients >80 years-old at diagnosis, it is important to understand if older patients are receiving similar benefits.
We identified 2155 patients diagnosed with myeloma at age 80 or older in the Surveillance, Epidemiology, and End Results Program (SEER)-Medicare database from 2007 to 2013. A cohort of 2933 similar patients diagnosed with myeloma at age 70-79 was used for comparison using a difference-in-differences design.
Only 51% of patients >80 years-old at diagnosis received systemic anti-myeloma treatment. Treatment was associated with a 26% decrease in hazard for death, independent of age, race, gender, poverty, comorbidities, and proxy measures of performance status. In the 70-79 cohort, treatment was associated with a 22% decrease in hazard for death. Based on the difference-in-differences design, there is no statistically significant difference in treatment benefit based on age cohort (p = .610).
Anti-myeloma treatment produces a similar survival benefit among the oldest patients. The population over 80, when myeloma incidence peaks, is projected to triple over the next few decades. It is imperative that we continue to advance our understanding of the needs of this vulnerable subgroup of patients with myeloma.
多发性骨髓瘤的治疗已取得巨大进展；然而，大部分成功案例都出现在年轻患者中。鉴于36%的患者在诊断时年龄超过80岁，了解老年患者是否能获得类似益处至关重要。
我们在2007年至2013年的监测、流行病学和最终结果计划（SEER）-医疗保险数据库中，识别出2155例80岁及以上被诊断为骨髓瘤的患者。采用差异中的差异设计，将一组2933例70 - 79岁被诊断为骨髓瘤的类似患者用于比较。
诊断时年龄超过80岁的患者中，只有51%接受了全身性抗骨髓瘤治疗。治疗与死亡风险降低26%相关，与年龄、种族、性别、贫困、合并症及功能状态的替代指标无关。在70 - 79岁的队列中，治疗与死亡风险降低22%相关。基于差异中的差异设计，不同年龄队列的治疗获益在统计学上无显著差异（p = 0.610）。
抗骨髓瘤治疗在最年长的患者中产生类似的生存获益。骨髓瘤发病率在80岁以上人群中达到峰值，预计在未来几十年内该人群数量将增至三倍。我们必须继续深入了解这一骨髓瘤弱势亚组患者的需求。
