Background: There is an increased risk of second primary malignancies (SMPs) in patients with multiple myeloma (MM). This multinational ‘real-world’ retrospective study analyzed the characteristics and outcomes of MM patients that developed SPMs. Results: 165 patients were analyzed: 62.4% males; 8.5% with a prior cancer; 113 with solid SPMs, mainly ≥stage 2; and 52 with hematological SPM (hemato-SPM), mainly MDS/AML. Patients with hemato-SPM were younger (p= 0.05) and more frequently had a prior AutoHCT (p= 0.012). The time to SPM was shorter in the older (>65 years) and more heavily pretreated patients. One hundred patients were actively treated at the time of SPM detection. Treatment was discontinued in 52, substituted with another anti-MM therapy in 15, and continued in 33 patients. Treatment discontinuation was predominant in the patients diagnosed with hemato-SPM (76%). The median OS following SPM detection was 8.5 months, and the main cause of death was SPM. A poor ECOG status predicted a shorter OS (PS 3 vs. 0, HR = 5.74, 2.32–14.21,p< 0.001), whereas a normal hemoglobin level (HR = 0.43, 0.19–0.95,p= 0.037) predicted longer OS. Conclusions: With the continuing improvement in OS, a higher proportion of MM patients might develop SPM. The OS following SPM diagnosis is poor; hence, frequent surveillance and early detection are imperative to improve outcomes.
背景：多发性骨髓瘤（MM）患者发生第二原发恶性肿瘤（SPM）的风险增加。这项多国“真实世界”回顾性研究分析了发生SPM的MM患者的特征与预后。结果：共分析165例患者：男性占62.4%；8.5%有既往癌症史；113例为实体瘤SPM（主要为≥2期），52例为血液系统SPM（以MDS/AML为主）。血液系统SPM患者更年轻（p=0.05），且既往接受自体造血干细胞移植的比例更高（p=0.012）。年龄较大（>65岁）及前期治疗强度更高的患者发生SPM的时间更短。在检测到SPM时，有100例患者正在接受积极治疗。其中52例中止治疗，15例更换其他抗MM治疗方案，33例继续原治疗。诊断为血液系统SPM的患者中治疗中止比例最高（76%）。SPM检测后的中位总生存期为8.5个月，主要死因为SPM。ECOG状态差预示总生存期缩短（PS 3对比0，HR=5.74，95%CI 2.32–14.21，p<0.001），而血红蛋白水平正常（HR=0.43，95%CI 0.19–0.95，p=0.037）预示总生存期更长。结论：随着总生存期的持续改善，可能有更高比例的MM患者发生SPM。SPM诊断后的总生存期较差，因此通过加强监测和早期发现以改善预后至关重要。
Outcome of Second Primary Malignancies Developing in Multiple Myeloma Patients
肿瘤(癌症)患者之家