Dores Graça M, Vo Jacqueline B, Schonfeld Sara J, Shing Jaimie Z, Taparra Kekoa, Morton Lindsay M, Curtis Rochelle E, Linet Martha S
Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
Br J Haematol. 2025 Jun 10. doi: 10.1111/bjh.20192.
Few population-based studies have rigorously evaluated overall survival (OS) differences among adults treated with chemotherapy and/or immunotherapy (chemo/immunotherapy) for multiple myeloma (MM) during the past two decades when the therapeutic landscape substantially evolved. We evaluated OS among 50 288 adults diagnosed with MM between 2000 and 2019 reported to have received initial chemo/immunotherapy. We calculated hazard ratios (HRs) using multivariable Cox regression to compare OS across calendar periods and within patient demographic groups. OS improved over time (2000-2004 = reference; HR = 0.77, 95% CI = 0.75-0.79; HR = 0.65, 95% CI = 0.63-0.67; HR = 0.56, 95% CI = 0.54-0.58) with a similar pattern across age, sex, racial-ethnic and county-level median household income groups. However, demographic differences were noted within each calendar period and persisted in 2015-2019, with more favourable survival among females (males = reference; HR = 0.91, 95% CI = 0.87-0.96) and consistently higher mortality among older patients (45-64 years = reference; HR = 1.69, 95% CI = 1.59-1.80; HR = 3.32, 95% CI = 3.08-3.58); Black, Hispanic and Pacific Islander patients (White = reference; HR = 1.07, 95% CI = 1.00-1.15; HR = 1.08, 95% CI = 1.00-1.16; HR = 1.85, 95% CI = 1.40-2.44); and patients living in counties with household incomes <$75 000. Despite progressive and significant improvement in patient survival following initial chemo/immunotherapy for MM, unmet medical needs persisted among older age groups; males; Black, Hispanic and Pacific Islander patients; and those living in lower income counties.
在过去二十年中，随着治疗格局的大幅演变，很少有基于人群的研究严格评估接受化疗和/或免疫疗法（化学/免疫疗法）治疗的成年多发性骨髓瘤（MM）患者的总生存期（OS）差异。我们评估了2000年至2019年间报告接受初始化学/免疫疗法的50288例成年MM患者的OS。我们使用多变量Cox回归计算风险比（HR），以比较不同日历期和患者人口统计学组内的OS。随着时间的推移，OS有所改善（2000 - 2004年=参考；HR = 0.77，95%CI = 0.75 - 0.79；HR = 0.65，95%CI = 0.63 - 0.67；HR = 0.56，95%CI = 0.54 - 0.58），在年龄、性别、种族和县级家庭收入中位数组中呈现相似模式。然而，在每个日历期内都注意到了人口统计学差异，并且在2015 - 2019年持续存在，女性的生存率更有利（男性=参考；HR = 0.91，95%CI = 0.87 - 0.96），老年患者的死亡率一直较高（45 - 64岁=参考；HR = 1.69，95%CI = 1.59 - 1.80；HR = 3.32，95%CI = 3.08 - 3.58）；黑人、西班牙裔和太平洋岛民患者（白人=参考；HR = 1.07，95%CI = 1.00 - 1.15；HR = 1.08，95%CI = 1.00 - 1.16；HR = 1.85，95%CI = 1.40 - 2.44）；以及生活在家庭收入<$75000县的患者。尽管MM患者初始化学/免疫疗法后的患者生存率有渐进性和显著改善，但老年人群、男性、黑人、西班牙裔和太平洋岛民患者以及生活在低收入县的患者中仍存在未满足的医疗需求。
