Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China.
Cancer Med. 2023 Apr;12(8):9604-9614. doi: 10.1002/cam4.5737. Epub 2023 Feb 21.
Significant advances in multiple myeloma (MM) over the past 15 years led to exciting changes in the management of MM patients in China, which in turn brought about the early diagnoses, precise risk stratifications, and improved prognoses.
We summarized the dynamic changes in the management of newly diagnosed (ND) MM in a national medical center, crossing the old and novel drug era. Demographics, clinical characteristics, first-line treatment, response rate, and survival were retrospectively collected among NDMMs diagnosed in Zhongshan Hospital Fudan University from January 2007 to October 2021.
Of the 1256 individuals, median age was 64 (range 31-89) with 45.1% patients >65 years. About 63.5% were male, 43.1% were at ISS stage III and 9.9% had light-chain amyloidosis. Patients with abnormal ratio of free light chain (80.4%), extramedullary disease (EMD, 22.0%), and high-risk cytogenetic abnormalities (HRCA, 26.8%) were detected by novel detection techniques. The best confirmed ORR was 86.5%, including 39.4% with CR. Short- and long-term PFS and OS rates persistently increased each year along with increasing novel drug applications. Median PFS and OS were 30.9 and 64.7 months. Advanced ISS stage, HRCA, light-chain amyloidosis and EMD independently predicted an inferior PFS. First-line ASCT indicated a superior PFS. Advanced ISS stage, elevated serum LDH, HRCA, light-chain amyloidosis, and receiving PI/IMiD-based regimen versus PI+IMiD-based regimen independently indicated a poorer OS.
In brief, we illustrated a dynamic landscape of MM patients in a national medical center. Chinese MM patients evidently benefited from newly introduced techniques and drugs in this field.
在过去的 15 年中，多发性骨髓瘤（MM）取得了重大进展，这导致中国 MM 患者的治疗发生了令人兴奋的变化，进而实现了早期诊断、精确的风险分层和改善的预后。
我们总结了复旦大学中山医院一个国家医学中心新诊断（ND）MM 管理的动态变化，跨越了新旧药物时代。回顾性收集了 2007 年 1 月至 2021 年 10 月在复旦大学中山医院诊断为 NDMM 的患者的人口统计学、临床特征、一线治疗、缓解率和生存情况。
在 1256 名患者中，中位年龄为 64 岁（范围 31-89 岁），45.1%的患者年龄＞65 岁。约 63.5%为男性，43.1%为 ISS 期 III 期，9.9%为轻链淀粉样变性。新型检测技术检测到游离轻链比值异常（80.4%）、髓外疾病（EMD，22.0%）和高危细胞遗传学异常（HRCA，26.8%）。最佳确证的总缓解率（ORR）为 86.5%，包括 39.4%的完全缓解率（CR）。随着新型药物应用的增加，短、长期 PFS 和 OS 率逐年持续提高。中位 PFS 和 OS 分别为 30.9 和 64.7 个月。高级 ISS 期、HRCA、轻链淀粉样变性和 EMD 独立预测 PFS 较差。一线 ASCT 提示 PFS 较好。高级 ISS 期、血清 LDH 升高、HRCA、轻链淀粉样变性和接受 PI/IMiD 为基础的方案而非 PI+IMiD 为基础的方案独立预示 OS 较差。
简而言之，我们展示了一个国家医学中心 MM 患者的动态情况。中国 MM 患者显然受益于该领域新引入的技术和药物。
