Alegre Adrián, Gironella Mercedes, Escalante Fernando, Bergua Juan M, Martínez-Chamorro Carmen, López Aurelio, González Esther, Bárez Abelardo, Somolinos Nieves, Persona Ernesto P, Cabrera Alexia S, Soler Alfons, Rodríguez Belén I, López Joaquín M, González Yolanda, Giménez Verónica C, Sampol Antonia, Muñoz Carolina, Vilanova David, Durán Marta, Fernández de Larrea Carlos
Hospital Universitario de la Princesa Madrid Spain.
Hospital Universitari Vall d'Hebron Barcelona Spain.
Hemasphere. 2024 Jul 4;8(7):e81. doi: 10.1002/hem3.81. eCollection 2024 Jul.
Recommendations regarding the best time to start treatment in patients with relapsed/refractory multiple myeloma (RRMM) after biological relapse/progression (BR) are unclear. This observational, prospective, multicenter registry aimed to evaluate the impact on time to progression (TTP) of treatment initiation at BR versus at symptomatic clinical relapse (ClinR) based on the Spanish routine practice in adult patients with RRMM. Patients had two or less previous treatment lines and at least one previous partial response. Baseline characteristics and treatment outcomes were recorded, and survival was analyzed. Of 225 patients, 110 were treated at BR (TxBR group) and 115 at ClinR (TxClinR group) according to the investigators' criteria. The proportion of patients with higher ECOG, previous noncomplete remission (CR), and second relapse were significantly higher in the TxBR group compared to the TxClinR group. TheTxClinR group showed improved outcomes, including TTP, compared to the TxBR group. Progression-free survival increased in the TxClinR group (56.2 months) compared to the TxBR group (32.5 months) ( = 0.0137), and median overall survival also increased ( = 0.0897). Median TTP was significantly longer in patients relapsing from a CR (50.4 months) and in their first relapse (38.7 months) compared to those relapsing from a non-CR response (32.9 months) and in their second relapse (25.2 months). Physicians seemed to start treatment earlier in RRMM patients with poor prognosis features. Previous responses to anti-MM treatment and the number of prior treatment lines were identified as prognosis factors, whereby relapse from CR and first relapse were associated with a longer time to progression.
关于复发/难治性多发性骨髓瘤（RRMM）患者在生物学复发/进展（BR）后开始治疗的最佳时间，目前尚无明确建议。这项观察性、前瞻性、多中心注册研究旨在根据西班牙成年RRMM患者的常规做法，评估在BR时开始治疗与在有症状临床复发（ClinR）时开始治疗对疾病进展时间（TTP）的影响。患者既往接受过的治疗线数为两条或更少，且至少有过一次部分缓解。记录基线特征和治疗结果，并分析生存率。根据研究者的标准，225例患者中，110例在BR时接受治疗（TxBR组），115例在ClinR时接受治疗（TxClinR组）。与TxClinR组相比，TxBR组中ECOG评分较高、既往未达到完全缓解（CR）以及第二次复发的患者比例显著更高。与TxBR组相比，TxClinR组的结局有所改善，包括TTP。TxClinR组的无进展生存期（56. months）较TxBR组（32.5个月）有所延长（ = 0.0137），中位总生存期也有所延长（ = 0.0897）。与从非CR反应复发的患者（32.9个月）及其第二次复发（25.2个月）相比，从CR复发的患者（50.4个月）及其首次复发（38.7个月）的中位TTP明显更长。医生似乎会在预后特征较差的RRMM患者中更早开始治疗。既往对抗骨髓瘤治疗的反应以及既往治疗线数被确定为预后因素，其中从CR复发和首次复发与更长的疾病进展时间相关。
