作为多发性骨髓瘤脆弱患者更有效的治疗方法,更强烈的治疗方法 [纠正]
Clark DuMontier1,2,3,4, Jennifer La4,5, John Bihn5
1New England Geriatrics Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA.
Blood advances
|August 15, 2023
概括
更强烈的博特佐米布-莱纳利多米德-脱沙美 (VRd) 治疗改善了新诊断的多发性骨髓瘤 (MM) 患者的生存率,包括那些有显著脆弱的患者. 这表明密集的MM疗法也可以治疗虚弱本身.
科学领域:
- 血液学 血液学 血液学
- 在瘤学瘤学.
- 老年病的医生 老年病的医生
背景情况:
- 随机对照试验表明,博尔特佐米布-莱纳利多米德-甲 (VRd) 对新诊断的多发性骨髓瘤 (MM) 优于莱纳利多米德-甲 (Rd).
- 临床指导方针历来倾向于Rd用于不能容忍三重治疗的脆弱患者.
- 脆弱性评估对于老年MM患者的治疗决策至关重要.
研究的目的:
- 为了比较VRd与Rd在美国退伍军人事务卫生保健系统中新诊断的MM患者的真实环境中的有效性.
- 研究通过退伍军人事务脆弱指数衡量的脆弱性对接受VRd或Rd的MM患者治疗结果的影响.
- 为了确定VRd对Rd的好处是否延伸到脆弱的患者群体.
主要方法:
- 对2573名新诊断的MM患者 (2004-2020年) 的回顾性分析,该分析始于VRd或Rd.
- 倾向性得分匹配用于根据MM阶段和其他混因素平衡患者组.
- 退伍军人事务脆弱性指数被用来将患者分为非脆弱,轻微脆弱和中度至严重脆弱的群体.
主要成果:
- 在总体匹配的MM人群中,VRd与Rd相比死亡率显著降低 (HR,0.81).
- 在中度至重度虚弱的患者中,VRd的生存益处最为明显 (HR,0.74),在轻度虚弱和非虚弱的群体中效果减弱.
- 虽然VRd与整体住院病例的适度增加有关,但这种关联在中度至重度虚弱患者中减弱.
结论:
- 研究结果证实,在美国老年MM患者中,VRd与Rd相比,VRd的生存结果优越.
- 强化VRd疗法在患有较高脆弱度的患者中显示出最大的益处.
- 多发性骨髓瘤的密集治疗策略可能通过解决脆弱性本身来提供双重好处.
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