Balitsky Amaris K, Sutradhar Rinku, Seow Hsien, Gayowsky Anastasia, Visram Alissa, Tay Jason, Sandhu Irwindeep, Mian Hira
Department of Oncology, McMaster University, Hamilton, ON L8V 5C2, Canada.
Hamilton Health Sciences, Juravinski Cancer Center, Hamilton, ON L8V 5C2, Canada.
Cancers (Basel). 2025 Feb 1;17(3):489. doi: 10.3390/cancers17030489.
Patients with transplant-ineligible (TIE) multiple myeloma (MM) have high rates of symptom burden. The aim of this study was to develop and validate a prognostic model to predict symptoms in patients with TIE MM.
In this population-based, retrospective cohort study, using multiple administrative health care databases linked using a unique encrypted patient identifier in Ontario, Canada, symptoms were identified using the patient self-reported Edmonton Symptom Assessment System (ESAS) at each clinic visit. The primary outcome was the presence of moderate-to-severe (ESAS score 4-10) symptoms (specifically symptoms of pain, tiredness, depression, and impaired well-being) within one year from the index date. Using the entire cohort, a multivariable logistic regression model with baseline covariates was developed to predict the risk of experiencing each of the above symptoms, categorized as moderate to severe within 1 year post-index date. Internal validation of the model was assessed via bootstrap validation methods.
A total of 1535 TIE adults with MM met the inclusion criteria. The median age was 75, with 25.2% of patients aged 80 years or older. In the multivariate analysis, baseline symptoms continued to be most associated with future symptom burden. Baseline severe pain (OR 9.84, 95% CI 6.29-15.7) was most associated with patients experiencing moderate-severe pain one year post-index date. Similarly, baseline severe tiredness (OR 17.34, 95% CI 9.00-33.42), baseline severe depression (OR 28.07, 95% CI 15.96-49.38), and baseline severely impaired well-being (OR 4.12, 95% CI 2.30-7.37) were the biggest predictors of patients experiencing moderate-severe tiredness, depression, and impaired well-being, respectively, at one year after the index date.
Patients with MM experience persisting symptoms of pain, tiredness, depression, and impaired well-being, with baseline symptoms being the biggest predictor of future symptom burden.
不符合移植条件（TIE）的多发性骨髓瘤（MM）患者症状负担率很高。本研究的目的是开发并验证一种预测模型，以预测TIE MM患者的症状。
在这项基于人群的回顾性队列研究中，利用加拿大安大略省通过唯一加密患者标识符链接的多个行政医疗保健数据库，在每次门诊就诊时使用患者自我报告的埃德蒙顿症状评估系统（ESAS）来识别症状。主要结局是自索引日期起一年内出现中度至重度（ESAS评分4 - 10）症状（特别是疼痛、疲劳、抑郁和幸福感受损症状）。使用整个队列，开发了一个包含基线协变量的多变量逻辑回归模型，以预测在索引日期后1年内经历上述每种症状（分类为中度至重度）的风险。通过自助验证方法评估模型的内部验证。
共有1535名患有MM的TIE成年患者符合纳入标准。中位年龄为75岁，25.2%的患者年龄在80岁及以上。在多变量分析中，基线症状仍然与未来症状负担最相关。基线严重疼痛（OR 9.84，95% CI 6.29 - 15.7）与索引日期后一年出现中度至重度疼痛的患者最相关。同样，基线严重疲劳（OR 17.34，95% CI 9.00 - 33.42）、基线严重抑郁（OR 28.07，95% CI 15.96 - 49.38）和基线严重幸福感受损（OR 4.12, 95% CI 2.30 - 7.37）分别是索引日期后一年出现中度至重度疲劳、抑郁和幸福感受损患者的最大预测因素。
MM患者会持续出现疼痛、疲劳、抑郁和幸福感受损症状，基线症状是未来症状负担的最大预测因素。
