Brieghel Christian, Lacoppidan Thomas, Packness Esben, Frederiksen Casper Møller, Werling Mikkel, Andersen Michael Asger, Poulsen Christian Bjørn, Rotbain Emelie Curovic, Niemann Carsten Utoft
Department of Hematology Copenhagen University Hospital-Rigshospitalet Copenhagen Denmark.
Hematology Branch, Danish Cancer Institute Copenhagen Denmark.
Hemasphere. 2025 Jul 16;9(7):e70172. doi: 10.1002/hem3.70172. eCollection 2025 Jul.
Polypharmacy is a result of multimorbidity and may limit treatment options in patients with lymphoid cancer (LC). To investigate the clinical impact of polypharmacy, we gathered a prediagnostic 1-year medication history from the Danish prescription register for 46,803 newly diagnosed patients with six lymphoma subtypes, chronic lymphocytic leukemia, and multiple myeloma (MM). Medication was grouped into individual drug classes ( = 79), polypharmacy, and the number of prescription medications and correlated with overall survival (OS), hospitalization, and severe infection. Adjusting for age, sex, and multiple testing, we demonstrated associations between 39 drug classes and OS, 29 drug classes and hospitalization, and 27 drug classes and severe infection. Although polypharmacy (<5 vs. ≥5) was associated with adverse outcomes (hazard ratio [HR] 1.4 for OS, hospitalization, and severe infection; P < 0.001), the number of medications (0-3 vs. 4-7 vs. 8-11 vs. >11) gradually stratified OS (HR 1.0 vs. 1.2 vs. 1.4 vs. 1.9, respectively; P < 0.001), hospitalization (HR 1.0 vs. 1.3 vs. 1.4 vs. 1.9, respectively; P < 0.001), and severe infection (HR 1.0 vs. 1.2 vs. 1.5 vs. 1.9, respectively; P < 0.001) in multivariable analyses adjusted for age, sex, comorbidity, and prognostic indices. Lastly, the time to next treatment for Hodgkin lymphoma, mantle cell lymphoma, and MM was gradually shorter with an increasing number of medications (P < 0.001). In conclusion, a 1-year medication history summarized as the number of medications is a strong, independent prognostic and predictive marker that should be considered as a key baseline characteristic in randomized clinical trials and in clinical practice for LC patients.
多重用药是多种疾病并存的结果，可能会限制淋巴癌（LC）患者的治疗选择。为了研究多重用药的临床影响，我们从丹麦处方登记处收集了46803例新诊断的六种淋巴瘤亚型、慢性淋巴细胞白血病和多发性骨髓瘤（MM）患者诊断前1年的用药史。药物被分为不同的药物类别（共79种）、多重用药情况以及处方药数量，并与总生存期（OS）、住院情况和严重感染进行关联分析。在对年龄、性别和多重检验进行校正后，我们发现39种药物类别与OS、29种药物类别与住院情况、27种药物类别与严重感染之间存在关联。尽管多重用药（<5种与≥5种）与不良结局相关（OS、住院和严重感染的风险比[HR]为1.4；P<0.001），但药物数量（0 - 3种与4 - 7种与8 - 11种与>11种）在对年龄、性别、合并症和预后指标进行多变量分析时，逐渐对OS（HR分别为1.0、1.2、1.4、1.9；P<0.001）、住院情况（HR分别为1.0、1.3、1.4、1.9；P<0.001）和严重感染（HR分别为1.0、1.2、1.5、1.9；P<0.001）进行了分层。最后，霍奇金淋巴瘤、套细胞淋巴瘤和MM患者下次治疗的时间随着药物数量的增加而逐渐缩短（P<0.001）。总之，总结为药物数量的1年用药史是一个强有力的、独立的预后和预测标志物，在随机临床试验和LC患者的临床实践中应被视为关键的基线特征。
