在NDMM的老年患者中,脆弱的子组决定了异质的结果 - - HOVON 143试验的长期随访
Febe Smits1, Kaz Groen1, Mark-David Levin2
1Amsterdam UMC, Amsterdam, Netherlands.
Blood advances
|August 22, 2025
概括
脆弱性显著影响多发性骨髓瘤的结果,但需要精确的定义. 在HOVON 143试验中,脆弱患者的存活率有所不同,这突显了除了年龄之外需要更好的风险分层.
科学领域:
- 血液学
- 老年病学
- 临床试验
背景情况:
- 在老年多发性骨髓瘤 (MM) 患者中,不仅仅是年龄决定了结果.
- 临床试验中经常缺少脆弱性评估,因此对脆弱人群的新疗法数据有限.
- 在脆弱的患者中存在显著的异质性,包括因年龄 (> 80) 导致的脆弱与老年障碍/并发症.
研究的目的:
- 报告HOVON 143试验的长期无进展生存 (PFS) 和整体生存 (OS) 结果,该试验专门为新诊断的MM的脆弱患者设计.
- 根据国际骨髓瘤工作组脆弱指数 (IMWG-FI) 分析脆弱子组的长期结果.
- 研究不同脆弱性定义 (年龄与损伤/并发症) 对治疗结果的影响.
主要方法:
- 在HOVON 143试验中,使用IMWG- FI进行分类,专门招募了新诊断的MM的虚弱患者.
- 患者接受了九个诱导周期的ixazomib,daratumumab和低剂量的甲,随后进行了维持治疗.
- 经过5年以上的中位数随访后,分析了长期的PFS和OS,并进行了详细的子组分析.
主要成果:
- 在该试验中,脆弱的MM患者的PFS中位数为13. 8个月,中位数的OS为34. 0个月.
- 根据脆弱的原因,分组分析显示出结果的显著异质性.
- 由于老年障碍而脆弱或被归类为"超脆弱"的患者的早期和非复发性死亡率高于仅因年龄而脆弱的患者.
结论:
- 这项研究强调了脆弱的MM群体中的异质性,影响了生存结果.
- 更精确的脆弱性定义对于识别患有早期死亡风险最高的患者至关重要.
- 这些发现强调了在脆弱的MM患者中需要量身定制的治疗策略和风险分层.
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