Rice Megan S, Naeger Sarah, Singh Erin
, 50 Binney Street, Cambridge, MA, 02142, USA.
Oncol Ther. 2021 Jun;9(1):195-212. doi: 10.1007/s40487-021-00146-4. Epub 2021 Mar 17.
Multiple myeloma (MM) is the second most frequent hematologic malignancy after lymphoma, contributing to approximately 10% of all hematologic malignancies. The prognosis of patients with MM is impacted by the heterogeneity of the disease, with worse outcomes reported in patients classified as International Staging System stage III, those with high-risk cytogenetics and elevated serum lactate dehydrogenase, and among patients who are elderly and have comorbidities. Previous studies have demonstrated an association between the presence of lung disease and worse outcomes; however, this impact in a real-world setting is not well understood.
This retrospective, observational, cohort study included data from the nationwide US Optum® de-identified electronic health record (EHR) database from January 1, 2006, to December 31, 2019. MM patients with asthma or chronic obstructive pulmonary disease (COPD) were compared with MM patients without asthma or COPD for time to next treatment and overall survival using one-sided log-rank tests stratified by age and multivariable Cox proportional hazard models.
Among 5186 patients with MM, approximately 15% had an asthma or COPD diagnosis (asthma/COPD) at baseline. The most commonly observed comorbidities among all MM patients and among those MM patients with asthma/COPD were cardiovascular disease, diabetes, and renal impairment. Time from first- to second-line treatment was significantly longer for patients with a diagnosis of COPD. Overall survival from first-line therapy was significantly worse among patients with COPD, with numerically worse overall survival from second-line therapy.
These real-world data suggest that patients with asthma or COPD do not experience a shorter time interval to next treatment, but have significantly worse overall survival from start of first-line therapy and numerically worse survival from the start of later lines. Future investigations with larger datasets may improve the understanding of the influence of individual treatments on outcomes in these patients.
多发性骨髓瘤（MM）是仅次于淋巴瘤的第二常见血液系统恶性肿瘤，约占所有血液系统恶性肿瘤的10%。MM患者的预后受疾病异质性影响，国际分期系统III期患者、具有高危细胞遗传学特征及血清乳酸脱氢酶升高的患者，以及老年且有合并症的患者预后较差。既往研究表明肺部疾病的存在与较差预后相关；然而，在现实环境中的这种影响尚不清楚。
这项回顾性、观察性队列研究纳入了2006年1月1日至2019年12月31日美国全国性的Optum®去识别电子健康记录（EHR）数据库中的数据。使用按年龄分层的单侧对数秩检验和多变量Cox比例风险模型，比较患有哮喘或慢性阻塞性肺疾病（COPD）的MM患者与无哮喘或COPD的MM患者至下次治疗的时间和总生存期。
在5186例MM患者中，约15%在基线时有哮喘或COPD诊断（哮喘/COPD）。所有MM患者以及患有哮喘/COPD的MM患者中最常见的合并症是心血管疾病、糖尿病和肾功能损害。诊断为COPD的患者从一线治疗到二线治疗的时间明显更长。COPD患者一线治疗后的总生存期明显更差，二线治疗后的总生存期在数值上也更差。
这些真实世界数据表明，患有哮喘或COPD的患者至下次治疗的时间间隔并不短，但从一线治疗开始的总生存期明显更差，从后续治疗线开始的生存期在数值上也更差。未来使用更大数据集的研究可能会增进对个体治疗对这些患者预后影响的理解。
