Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea.
Department of Medicine, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, South Korea.
Int J Hematol. 2021 Jan;113(1):81-91. doi: 10.1007/s12185-020-02988-6. Epub 2020 Sep 5.
We compared efficacy and safety, according to frailty, of elderly patients with relapsed and refractory multiple myeloma (RRMM) treated with lenalidomide and dexamethasone (Rd), for whom bortezomib treatment had failed. Patients, 164 (52.9%) and 146 (47.1%), were classified as non-frail and frail using a simplified frailty scale. The overall response rates (ORR) and survival outcomes were lower in frail than in non-frail patients (ORR: 56.2% vs. 67.7%, P = 0.069; median progression free survival: 13.17 vs. 17.80 months, P = 0.033; median overall survival: 23.00 vs. 36.27 months, P = 0.002, respectively). The number of treatment emergent adverse events in grade 3 or worse was higher in frail than in non-frail patients (41.8% vs. 24.4%, P = 0.002, respectively). In frail patients, independent poor prognostic factors for survival were two or more Charlson comorbidity index (CCI) score, prior to exposure to both bortezomib and thalidomide, and achieved less than partial response In conclusion, frailty could predict clinical outcomes of Rd treatment in elderly patients with RRMM who had failed prior bortezomib. In frail patients, lower CCI in addition to less previous treatment exposure and deep response were associated with better survival.
我们比较了复发/难治性多发性骨髓瘤（RRMM）老年患者的疗效和安全性，这些患者接受来那度胺和地塞米松（Rd）治疗，此前的硼替佐米治疗失败。使用简化的虚弱量表，164 名（52.9%）和 146 名（47.1%）患者被分类为非虚弱和虚弱。虚弱患者的总体缓解率（ORR）和生存结果低于非虚弱患者（ORR：56.2% vs. 67.7%，P=0.069；无进展生存期中位数：13.17 与 17.80 个月，P=0.033；总生存期中位数：23.00 与 36.27 个月，P=0.002）。3 级或更高级别的治疗突发不良事件在虚弱患者中高于非虚弱患者（41.8%与 24.4%，P=0.002）。在虚弱患者中，生存的独立不良预后因素是两个或更多的 Charlson 合并症指数（CCI）评分、先前暴露于硼替佐米和沙利度胺、以及获得不完全缓解。结论，虚弱可预测先前接受硼替佐米治疗的复发/难治性多发性骨髓瘤老年患者 Rd 治疗的临床结果。在虚弱患者中，除了先前的治疗暴露较少和深度缓解外，CCI 较低与更好的生存相关。
