文章：

重新定义多发性骨髓瘤（MM）中的流失：加拿大骨髓瘤研究组（CMRG）分析

Redefining attrition in multiple myeloma (MM): a Canadian Myeloma Research Group (CMRG) analysis

原文发布日期：2023-07-20

DOI: 10.1038/s41408-023-00883-x

类型: Article

开放获取: 是

英文摘要：

While most patients diagnosed with multiple myeloma (MM) receive initial therapy, reported attrition rates are high. Understanding attrition rates and characteristics of patients not receiving subsequent therapy is useful for MM stakeholders. We performed an analysis of attrition rates in a large disease-specific database of patients with newly diagnosed MM who received at least one line of therapy between Jan 1/10-Dec 31/20. Attrition was defined as failure to receive a subsequent line of therapy despite progression of MM or due to death. A total of 5548 patients were identified, 3111 autologous stem cell transplant (ASCT) patients and 2437 non-ASCT. In the ASCT cohort, the attrition rate was 7% after line 1, 12% after line 2, and 23% after line 3. In non-ASCT patients, the attrition rate was 19% after line 1, 26% after line 2, and 40% after line 3. Death was the dominant contributor to attrition across all cohorts, with a minority of patients alive with progressive disease in the absence of further therapy at each line. Multivariable analysis identified older age, shorter time to progression, and inferior response as independent risk factors for attrition. Our data show that attrition rates increase with each line of therapy and are higher in non-ASCT patients but are appreciably lower than previously reported. This study supports a revision of the previous definition of attrition, demonstrating that most patients who do not receive subsequent therapy are either continuing their current therapy and/or are in remission off-treatment rather than being irreversibly lost to attrition.
 

摘要翻译： 

尽管大多数确诊为多发性骨髓瘤的患者接受了初始治疗，但报道的治疗中断率居高不下。了解治疗中断率及未接受后续治疗患者的特征对多发性骨髓瘤的相关方具有重要参考价值。我们基于一个大型疾病专项数据库进行了治疗中断率分析，该数据库纳入了2010年1月1日至2020年12月31日期间确诊并接受至少一线治疗的新诊断多发性骨髓瘤患者。治疗中断定义为尽管疾病进展或因死亡而未能接受后续治疗。研究共纳入5548例患者，其中自体干细胞移植患者3111例，非移植患者2437例。在移植队列中，一线治疗后中断率为7%，二线后为12%，三线后达23%；非移植患者中，一线后中断率为19%，二线后为26%，三线后达40%。死亡是所有队列中治疗中断的主要原因，仅有少数患者在疾病进展且未接受进一步治疗的情况下存活。多变量分析显示，年龄增长、疾病进展时间缩短及治疗反应欠佳是治疗中断的独立危险因素。我们的数据显示，治疗中断率随治疗线数增加而上升，非移植患者中断率更高，但明显低于既往报道。本研究支持修订既往对治疗中断的定义，表明大多数未接受后续治疗的患者实际上是继续当前治疗和/或处于停药缓解期，而非永久性治疗脱落。

原文链接：

Redefining attrition in multiple myeloma (MM): a Canadian Myeloma Research Group (CMRG) analysis