Altmış beş yaş ve üstü multipl myelom tanılı hastalarda tedavi yanıtları, sağkalım ve bunlara etki eden faktörlerin geriye dönük olarak incelenmesi
Retrospectıve analysıs of factors affectıng treatment response, and survıval of multıple myeloma patıents aged 65 years and over
Yazar: ALİ TUNÇ
Danışman: DOÇ. DR. AYŞE SALİHOĞLU
İstanbul Üniversitesi-Cerrahpaşa / Cerrahpaşa Tıp Fakültesi / İç Hastalıkları Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2021
Konu: Hematoloji = Hematology
Dizin: Geriatri = Geriatrics ; Kök hücre taransplantasyonu = Stem cell transplantation ; Kök hücreler = Stem cells ; Multipl miyelom = Multiple myeloma ; Retrospektif çalışmalar = Retrospective studies ; Sağkalım = Survival ; Tedavi = Treatment

Özet:
Amaç: Bu çalışmada ≥65 yaş Multipl Myelom (MM) tanısı alan hastaların tedavi yanıtları, sağkalımları ve bunlara etki eden faktörlerin geriye dönük olarak incelenmesi amaçlanmıştır.
Gereç ve Yöntem: Ocak 2010-Ocak 2020 arasında MM tanısı alan ≥65 yaş hastaların demografik, klinik, laboratuvar, histopatolojik özellikleri, tedaviler ve yanıtları, sağkalımlar, sağkalım üzerinde etkili faktörler incelenmiştir.
Bulgular: Bu çalışma 123 hastayı kapsamaktadır. Hastaların 67'si erkekti. Ortanca takip süresi 28 ay, genel sağkalım (OS): 46 ay, progresyonsuz sağkalım (PFS): 17 ay saptandı. Takiplerde 78 hasta kaybedildi. Hastalar 65-69, 70-74, ≥75 yaş olarak gruplandırıldığında artan yaş ile OS'de azalma saptandı (sırasıyla: 68, 45, 36 ay p:0.022). En sık izotip IgG (%52.9), CRAB bulgusu litik kemik lezyonu (%64.3) oldu. Sağkalımı en iyi yansıtan R-ISS evrelemesi oldu. Yaş, anemi, böbrek yetmezliği, hiperkalsemi, hipoalbüminemi, kemik iliği plazma hücre oranı ≥ %26.5, ekstramedüller hastalık (EMH) varlığı kısa OS ile ilişkili bulundu. Çok değişkenli analizde hipoalbüminemi, kemik iliği plazma hücre oranı ve EMH varlığı OS üzerinde etkili bulundu. Bu üç değişkenle yapılan risk skorlamasında artan risk skoru ile azalan sağkalım ilişkisi anlamlı bulundu. Yaşam süresi üzerinde skor 0 referans alındığında 1 olanlar 4.047 kat, 2 olanlar 6.912 kat, 3 olanlar 20.865 kat daha riskli bulundu. Birinci basamakta MPV tedavisi uzun PFS,

Abstract:
Objective: In this study, it was aimed to retrospectively examine the treatment responses and survival of Multiple Myeloma (MM) patients aged ≥ 65 years and the factors affecting these parameters.
Materials and Methods: Demographic, clinical, laboratory, histopathological characteristics, treatment modalities and responses, survival, and factors affecting the outcome of patients diagnosed with MM aged ≥ 65 years between January 2010 and January 2020 were analysed.
Results: This study included 123 patients. Sixty-seven of the patients were male. Median follow up was 28 months, overall survival (OS): 46 months, progression-free survival (PFS): 17 months. Death occurred in 78 patients during follow up. The patients were stratified into 3 groups according to the age (65-69, 70-74, and ≥75 years). Increasing age was associated with decreasing OS (respectively: 68, 45, 36 months p:0.022). The most common isotype was IgG (52.9%), CRAB finding was lytic bone lesion (64.3%). R-ISS best reflected survival. Age, anemia, renal failure, hypercalcemia, hypoalbuminemia, bone marrow plasma cell ratio ≥26.5%, presence of extramedullary disease (EMD) were found to be associated with short OS. In multivariate analysis, hypoalbuminemia, bone marrow plasma cell ratio ≥26.5%, presence of EMD were found to affect OS. In risk scoring made with these three variables, the relationship between increased risk score and decreased survival was found to be statistically significant. When a score of 0 is taken as a reference on life expectancy, those with score 1 were found to be at a risk of 4.047 times, those with 2 were at 6.912 times and those with 3 were found to be at a risk of 20.865 times. MPV treatment in frontline setting was associated with longer PFS. Response less than PR following first-line therapy was associated with shorter OS. At the second line, RD treatment was not found to be superior to bortezomib-based treatments. Autologous stem cell transplantation (ASCT) was performed in 11 patients and OS in these patients was found to be longer, although not statistically significant, compared to patients who did not undergo ASCT (66 vs 45 months, p:0.256).
Conclusion: Age, anemia, renal failure, hypercalcemia, hypoalbuminemia, bone marrow plasma cell ratio ≥26.5%, presence of EMD were associated with short survival. MPV treatment at the frontline setting was associated with long PFS and