文章：

引入新疗法前后多发性骨髓瘤患者的第二原发性恶性肿瘤风险模式

Patterns of second primary malignancy risk in multiple myeloma patients before and after the introduction of novel therapeutics

原文发布日期：2013-06-28

DOI: 10.1038/bcj.2013.19

类型: Original Article

开放获取: 是

英文摘要：

Recent studies have reported an increased risk of second primary malignancies (SPM) following multiple myeloma (MM) diagnosis associated with novel anti-myeloma treatments. We evaluated the risk of SPM among 36 491 MM cases reported to the Surveillance, Epidemiology, and End Results program (SEER) between 1973 and 2008. We calculated overall and site-specific standardized incidence ratio (SIR) and 95% confidence intervals (CI) for 2012 SPM cases diagnosed within the 35-year follow-up. There was no significant overall risk of SPM (SIR=0.98; 95% CI=0.94–1.02); however, there were multiple site-specific risk patterns. The risk of breast and prostate cancer was significantly decreased overall and across age, latency and the year of diagnosis strata. There was an ∼50% increased risk of colorectal cancer 5 years after MM diagnosis (Ptrend<0.001). The risk of hematological malignancies was significantly increased, notably for acute myeloid leukemia (AML; SIR=6.51; 95% CI=5.42–7.83). There was a significant decreasing trend for AML over time, particularly for patients ⩾65. However, no significant change in risk was noted after the introduction of autologous stem cell transplant among younger patients (<65 years). On the basis of observed trends for overall SPM as well as AML, no association between the introduction of novel therapies and SPM following MM has emerged in this large population-based study.

摘要翻译： 

近期研究报道，随着新型抗骨髓瘤治疗的应用，多发性骨髓瘤诊断后继发第二原发恶性肿瘤的风险有所增加。我们基于监测、流行病学和最终结果计划数据库，对1973年至2008年间报告的36,491例多发性骨髓瘤病例进行了第二原发恶性肿瘤风险评估。通过计算35年随访期间确诊的2012例第二原发恶性肿瘤的总体及部位特异性标准化发病比及其95%置信区间，发现总体第二原发恶性肿瘤风险无显著升高（标准化发病比=0.98；95%置信区间=0.94-1.02），但存在多种部位特异性风险模式。乳腺癌和前列腺癌风险在各年龄段、潜伏期及诊断年份分层中均显著降低。骨髓瘤诊断5年后结直肠癌风险增加约50%（趋势检验P值<0.001）。血液系统恶性肿瘤风险显著上升，尤其急性髓系白血病（标准化发病比=6.51；95%置信区间=5.42-7.83）。随时间推移，急性髓系白血病风险呈显著下降趋势，在≥65岁患者中尤为明显。然而在年轻患者（<65岁）中，自体干细胞移植技术的引入并未导致风险发生显著改变。本项大规模人群研究基于观察到的总体第二原发恶性肿瘤及急性髓系白血病风险趋势，尚未发现新型疗法与多发性骨髓瘤后继发第二原发恶性肿瘤之间存在关联。

原文链接：

Patterns of second primary malignancy risk in multiple myeloma patients before and after the introduction of novel therapeutics