年龄不是障碍：CIBMTR 对接受自体造血细胞移植治疗多发性骨髓瘤的老年患者的分析。
Age no bar: A CIBMTR analysis of elderly patients undergoing autologous hematopoietic cell transplantation for multiple myeloma.
机构信息
MedStar Georgetown University Hospital, Washington, DC.
John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey.
出版信息
Cancer. 2020 Dec 1;126(23):5077-5087. doi: 10.1002/cncr.33171. Epub 2020 Sep 23.
BACKGROUND
Upfront autologous hematopoietic stem cell transplantation (AHCT) remains an important therapy in the management of patients with multiple myeloma (MM), a disease of older adults.
METHODS
The authors investigated the outcomes of AHCT in patients with MM who were aged ≥70 years. The Center for International Blood and Marrow Transplant Research (CIBMTR) database registered 15,999 patients with MM in the United States within 12 months of diagnosis during 2013 through 2017; a total of 2092 patients were aged ≥70 years. Nonrecurrence mortality (NRM), disease recurrence and/or progression (relapse; REL), progression-free survival (PFS), and overall survival (OS) were modeled using Cox proportional hazards models with age at transplantation as the main effect. Because of the large sample size, a P value <.01 was considered to be statistically significant a priori.
RESULTS
An increase in AHCT was noted in 2017 (28%) compared with 2013 (15%) among patients aged ≥70 years. Although approximately 82% of patients received melphalan (Mel) at a dose of 200 mg/m overall, 58% of the patients aged ≥70 years received Mel at a dose of 140 mg/m . On multivariate analysis, patients aged ≥70 years demonstrated no difference with regard to NRM (hazard ratio [HR] 1.3; 99% confidence interval [99% CI], 1-1.7 [P = .06]), REL (HR, 1.03; 99% CI, 0.9-1.1 [P = 0.6]), PFS (HR, 1.06; 99% CI, 1-1.2 [P = 0.2]), and OS (HR, 1.2; 99% CI, 1-1.4 [P = .02]) compared with the reference group (those aged 60-69 years). In patients aged ≥70 years, Mel administered at a dose of 140 mg/m was found to be associated with worse outcomes compared with Mel administered at a dose of 200 mg/m , including day 100 NRM (1% [95% CI, 1%-2%] vs 0% [95% CI, 0%-1%]; P = .003]), 2-year PFS (64% [95% CI, 60%-67%] vs 69% [95% CI, 66%-73%]; P = .003), and 2-year OS (85% [95% CI, 82%-87%] vs 89% [95% CI, 86%-91%]; P = .01]), likely representing frailty.
CONCLUSIONS
The results of the current study demonstrated that AHCT remains an effective consolidation therapy among patients with MM across all age groups.
背景
upfront 自体造血干细胞移植（AHCT）仍然是多发性骨髓瘤（MM）患者治疗的重要方法，MM 是一种老年疾病。
方法
作者研究了≥70 岁 MM 患者 AHCT 的结果。美国国际血液和骨髓移植研究中心（CIBMTR）数据库在 2013 年至 2017 年期间登记了 15999 例在美国确诊后 12 个月内的 MM 患者；共有 2092 例患者年龄≥70 岁。非复发死亡率（NRM）、疾病复发和/或进展（relapse；REL）、无进展生存期（PFS）和总生存期（OS）采用 Cox 比例风险模型进行建模，移植时的年龄为主要因素。由于样本量较大，预先认为 P 值<.01 具有统计学意义。
结果
与 2013 年（15%）相比，≥70 岁患者的 AHCT 在 2017 年有所增加（28%）。尽管总体上约 82%的患者接受了美法仑（Mel）剂量为 200mg/m2，但 58%的≥70 岁患者接受了 Mel 剂量为 140mg/m2。多变量分析显示，≥70 岁患者的 NRM（危险比 [HR] 1.3；99%置信区间 [99%CI]，1-1.7 [P=0.06]）、REL（HR，1.03；99%CI，0.9-1.1 [P=0.6]）、PFS（HR，1.06；99%CI，1-1.2 [P=0.2]）和 OS（HR，1.2；99%CI，1-1.4 [P=0.02]）与参考组（年龄 60-69 岁）相比无差异。在≥70 岁的患者中，与 200mg/m2 相比，140mg/m2 剂量的 Mel 与更差的结局相关，包括第 100 天的 NRM（1%[95%CI，1%-2%] vs 0%[95%CI，0%-1%]；P=0.003]）、2 年 PFS（64%[95%CI，60%-67%] vs 69%[95%CI，66%-73%]；P=0.003]）和 2 年 OS（85%[95%CI，82%-87%] vs 89%[95%CI，86%-91%]；P=0.01]），这可能与虚弱有关。
结论
本研究结果表明，AHCT 仍然是所有年龄组 MM 患者的有效巩固治疗方法。
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