Teixeira Marina Xavier, Reis Adriano Max Moreira, Drummond Paula Lana de Miranda, Malta Jéssica Soares, Silveira Lívia Pena, Menezes de Pádua Cristiane Aparecida
Department of Social Pharmacy, Federal University of Minas Gerais - UFMG, Avenida Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, Brazil.
Department of Pharmaceutical Products, Federal University of Minas Gerais - UFMG, Belo Horizonte, Brazil.
Ann Hematol. 2024 Dec;103(12):5881-5889. doi: 10.1007/s00277-024-05684-1. Epub 2024 Mar 9.
Multiple myeloma (MM) is an incurable hematological cancer requiring multiple lines of anti-myeloma regimens to promote disease remission and increase patient survival. The study assessed the incidence and reasons for discontinuation of first-line therapy in outpatients who started MM therapy in Belo Horizonte, Brazil from 2009 to 2020. A historical cohort study in which patients were followed from treatment initiation until discontinuation of first-line therapy. Discontinuation of first-line therapy was characterized as (i) discontinuation followed by a second-line therapy, and (ii) discontinuation that prevented patients from receiving a subsequent line of treatment. Non-parametric competing risk analysis with a 95% confidence interval estimated the cumulative incidences of discontinuation followed by a second-line therapy. The probability of discontinuation was compared according to selected variables using the Gray's test at a significance level of 5%. Approximately half of the participants (n = 260) were female and younger than 65 years. Discontinuation of first-line therapy followed by a second-line therapy accounted for 50.4% of the patients and occurred up to 30th month. The main reason for discontinuation not qualifying patients for receiving second-line therapy was to achieve a response to treatment. The maximum times for discontinuation not followed by a second-line therapy ranged from 12 to 20 months due to deaths or response to treatment. The probability of receiving second-line therapy was higher among patients initiating therapy in 2009-2014 and those not undergoing transplantation. In conclusion, discontinuation of first-line therapy followed by second-line treatment occurred as likely as the discontinuation not followed by a subsequent line.
多发性骨髓瘤（MM）是一种无法治愈的血液系统癌症，需要多线抗骨髓瘤方案来促进疾病缓解并提高患者生存率。该研究评估了2009年至2020年在巴西贝洛奥里藏特开始接受MM治疗的门诊患者一线治疗的中断发生率及原因。这是一项历史性队列研究，对患者从治疗开始直至一线治疗中断进行随访。一线治疗中断的定义为：（i）中断后接受二线治疗；（ii）中断导致患者无法接受后续治疗。采用95%置信区间的非参数竞争风险分析估计中断后接受二线治疗的累积发生率。使用格雷检验在5%的显著性水平下根据选定变量比较中断概率。大约一半的参与者（n = 260）为女性且年龄小于65岁。中断一线治疗后接受二线治疗的患者占50.4%，发生时间最长至第30个月。导致患者不符合接受二线治疗条件的主要中断原因是治疗取得缓解。因死亡或治疗反应导致未接受二线治疗的最长中断时间为12至20个月。在2009 - 2014年开始治疗的患者以及未接受移植的患者中接受二线治疗的概率更高。总之，中断一线治疗后接受二线治疗的情况与未接受后续治疗的中断情况发生率相近。
