Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
Beacon Hospital, Petaling Jaya, Selangor, Malaysia.
Asian Pac J Cancer Prev. 2024 Feb 1;25(2):595-601. doi: 10.31557/APJCP.2024.25.2.595.
Multiple myeloma is the third most common hematologic malignancy in Malaysia. The introduction of novel agents over the past decades has improved patient outcome and survival substantially. However, these agents incur significant economic burden, thus leading to limited use in less developed countries. This study aims to report on the real-world treatment pattern and outcome of newly diagnosed multiple myeloma (NDMM) patients from a resource-constraint setting.
This is a retrospective study on NDMM patients diagnosed between 1 January 2008 and 31 December 2022 in a single academic center. Patients' demographic and treatment details were included for analysis of progression free survival (PFS) and overall survival (OS).
One hundred and thirty-six NDMM patients with a median age of 64.0 years (ranged from 38 to 87 years old) were included. Bortezomib-containing regimens were the most commonly used induction agent, followed by thalidomide. Almost half of the patients (47.1%) achieved very good partial response (VGPR) or complete remission (CR), while 31.6% achieved partial response (PR). Bortezomib containing regimen was associated with significantly deeper and more rapid response, (p=0.001 and p=0.017, respectively) when compared to other agents. Only 22.8% of these patients proceeded to upfront autologous haematopoietic stem cell transplantation. The median OS and PFS were 60.0 months and 25.0 months, respectively. Best initial response and upfront autologous stem cell transplantation (ASCT) were significantly associated with better PFS.
Achieving at least a VGPR significantly associated with better outcome in NDMM patients. In a resource constrain country, we recommend incorporating bortezomib in the induction therapy followed with an upfront ASCT.
多发性骨髓瘤是马来西亚第三大常见血液系统恶性肿瘤。在过去几十年中，新型药物的引入极大地改善了患者的预后和生存。然而，这些药物带来了巨大的经济负担，因此在欠发达国家的使用受到限制。本研究旨在报告资源有限环境下初诊多发性骨髓瘤（NDMM）患者的真实世界治疗模式和结局。
这是一项回顾性研究，纳入了 2008 年 1 月 1 日至 2022 年 12 月 31 日期间在一家学术中心确诊的 NDMM 患者。分析无进展生存期（PFS）和总生存期（OS）时纳入了患者的人口统计学和治疗细节。
共纳入 136 例 NDMM 患者，中位年龄为 64.0 岁（38-87 岁）。硼替佐米为最常用的诱导治疗药物，其次是沙利度胺。接近一半的患者（47.1%）达到非常好的部分缓解（VGPR）或完全缓解（CR），31.6%达到部分缓解（PR）。与其他药物相比，硼替佐米方案诱导治疗具有更深和更快的缓解（p=0.001 和 p=0.017）。这些患者中只有 22.8%直接进行了自体造血干细胞移植（ASCT）。中位 OS 和 PFS 分别为 60.0 个月和 25.0 个月。最佳初始缓解和直接 ASCT 与更好的 PFS 显著相关。
在 NDMM 患者中，至少达到 VGPR 与更好的结局显著相关。在资源有限的国家，我们建议在诱导治疗中加入硼替佐米，随后进行直接 ASCT。
