Real World Outcome of High-Risk Multiple Myeloma: An Indian Tertiary Care Centre Experience.

IF 2.7 4区医学 Q2 HEMATOLOGY Clinical Lymphoma, Myeloma & Leukemia Pub Date : 2024-09-22 DOI:10.1016/j.clml.2024.09.007

Anveshika Soni, Sujay Rainchwar, Reema Singh, Dikshat Gopal Gupta, Nakul Tikare, Rohan Halder, Roy J Palatty, Vipul Sharad Sheth, Narendra Agrawal, Dinesh Bhurani, Tribikram Panda

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Abstract

Introduction: High risk myeloma is heterogeneous with significant variation in risk stratifications. Real world outcomes differ from controlled clinical trials and affected by socioeconomical determinants.

Material and methods: This retrospective study was performed in a North Indian teriarty care cancer hospital. Out of 384,76(19.7%) high risk myeloma patients (median age 58 years) were analyzed.

Result and conclusion: Most common HRCA was 1 q gain 36(47.4%) followed by del17p 32(42.1%). 61/76(80.2%) received bortezomib based triplets and 15(19.74%) daratumumab based quadruplets induction, 31(40.79%) received ASCT. Median duration of follow up was 19.5 months. The 2 year OS and PFS was 73.8%, 52.6% respectively. Estimated 3 year OS was 74.7% in ASCT cohort versus 52.9% (P = .0067) without. Estimated 3-year PFS in the ASCT cohort was 72.1% versus 30.3% (P = .0026) without. Estimated 3-year OS for single hit and multi hit ultra HRMM was 67.7% and 61.9% (P = .642) whereas PFS was 58.2% and 35.2% (P = .486) respectively. In multivariate analysis ASCT correlated with better OS (HR 0.3, P = .041) and PFS (HR 0.35, P = .012). Absence of baseline renal impairment correlated with better OS (HR 4.12, P = .004) only. Early aggressive therapy with prompt ASCT translates to a better survival in high risk myeloma. Emphasis on real world clinical outcome is the need of the hour for addressing practical issues and improving global myeloma outcome.

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高风险多发性骨髓瘤的实际治疗效果：印度三级医疗中心的经验

导言：高风险骨髓瘤是一种异质性疾病，其风险分层存在显著差异。实际结果与对照临床试验不同，并受到社会经济因素的影响：这项回顾性研究是在北印度的一家癌症治疗医院进行的。分析了 384 名高风险骨髓瘤患者中的 76 人（19.7%）（中位年龄 58 岁）：最常见的 HRCA 是 1 q 增益 36（47.4%），其次是 del17p 32（42.1%）。61/76（80.2%）例患者接受了以硼替佐米为基础的三联诱导，15（19.74%）例患者接受了以达拉曲单抗为基础的四联诱导，31（40.79%）例患者接受了 ASCT。中位随访时间为19.5个月。2年的OS和PFS分别为73.8%和52.6%。ASCT队列的估计3年OS为74.7%，而未接受ASCT的为52.9%（P = .0067）。ASCT队列的估计3年PFS为72.1%，而未接受ASCT的为30.3%（P = .0026）。单发和多发超 HRMM 的估计 3 年 OS 分别为 67.7% 和 61.9% (P = .642)，而 PFS 分别为 58.2% 和 35.2% (P = .486)。在多变量分析中，ASCT与更好的OS（HR 0.3，P = .041）和PFS（HR 0.35，P = .012）相关。无基线肾功能损害仅与更好的OS相关（HR 4.12，P = .004）。早期积极治疗并及时进行ASCT可提高高危骨髓瘤患者的生存率。重视实际临床结果是解决实际问题和改善全球骨髓瘤预后的当务之急。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Lymphoma, Myeloma & Leukemia ONCOLOGY-HEMATOLOGY

CiteScore

2.70

自引率

3.70%

发文量

1606

审稿时长

26 days

期刊介绍： Clinical Lymphoma, Myeloma & Leukemia is a peer-reviewed monthly journal that publishes original articles describing various aspects of clinical and translational research of lymphoma, myeloma and leukemia. Clinical Lymphoma, Myeloma & Leukemia is devoted to articles on detection, diagnosis, prevention, and treatment of lymphoma, myeloma, leukemia and related disorders including macroglobulinemia, amyloidosis, and plasma-cell dyscrasias. The main emphasis is on recent scientific developments in all areas related to lymphoma, myeloma and leukemia. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.