| Objective:For future direction,to learn the lesion and experience from clinical practice of the New Diagnosed Multiple Myeloma(NDMM)patients in real world by analyzing the data documented in our hospital in last decade.The corresponded data included general condition,clinical characteristics,survival prognostic factors,treatment,outcome,and description of the impact factors on super early death(SED)patients.Methods:The documented data of 112 NDMM patients in our hospital from November 8,2009 to January 5,2021,was collected,corresponding to admission time,age,sex,symptoms,basic diseases,ECOG score,blood routine,biochemistry,Bone Marrow MICM,serum immunoglobulin,β 2-microglobulin,blood and urine immunofixation electrophoresis,free light chain in urine and serum,treatment regimen,time of death and time of lost visit,cause of death.To describe baseline data of NDMM patients and analyze the factors on overall survival(OS),death,ESD by using SPSS 25.0 software.Results:1.From November 8,2009 to January 5,2021,the onset of NDMM is increasing and a total of patients 112 in our hospital.2.The baseline of 112 patients: median age 62(34-89)years,male to female ratio 1.8:1(72:40),DS Ⅲ stage 61 cases(54.46%),ISS Ⅲ stage 52 cases(46.43%),serum creatinine≥177μmol/L 47 case(41.96%),bone disease 82 cases(79.61%),ECOG scores≥2 65 cases(66.96%),IRPI ≥2 55 cases(49.11%),Ig G subtype 59 cases(59.60%),λ type 65 cases(63.16%).3.The most frequent complaint was pain(including chest,waist,back,lower limbs,shoulder,and neck)60 cases(53.57%),then dizziness 27 cases(24.11%).The frequent commodities were hypertension 40 cases(35.71%)and diabetes 26cases(23.21%).4.Survival outcome: 42 patients(37.5%)survived,42 patients(37.5%)died,and 28patients(25%)were lost to follow-up.The survival time for 42 dead patients: 17cases<3 months,9 cases≥3 and<12 months,9 cases≥1 year and<2 years,5 cases≥ 2 years and<3 years,2 cases ≥3 years.5.The median survival time of 112 patients was 95(0-127)months,and survival rate for the1,2,3,4,8years was:75.6%,65.9%,56.7%,53.2% and 26.6%.The median survival time of 84 patients who received at least 2 courses of induction therapy was95(0-127)months,survival rate for 1,2,3.4,8 years were: 87.7%,76.8%,65.50%,61.40%,30.70%.Patients receiving induction therapy with one new drug(without transplantation)had a median survival time of 27(0-89)months,1,2,3 year survival rate of 75.1%,57.8%,37.5%.Patients treated with the two new drugs combined(without transplantation)had a median survival time of 95(1-127)months,with 1,2,8year survival rate of 89%,76.4%,of 38.2%.The median survival time of patients receiving transplantation after induction therapy was 80.0% at 4 years.6.108(96.42%)cases received MM treatment,4(3.57%)died before starting treatment,24 patients(25%)completed one course of induction therapy,and 84 patients(75%)received at least two courses of induction therapy.7.Therapy lines in 84 patients,38(45.23%)cases completed the first-line therapy,36(42.86%)cases completed the second-line therapy,and 10(16%)cases completed the third-line and more line therapy.8.Therapy responds in 42 patients was assessed: 26 responded VGPR and more,16 patients failed to achieve VGPR.9.Prognostic factors for OS1)Therapy regimes: 4 accessible novel drugs were assigned in 2 types: the proteasome inhibitors(Bortezomib,Isadzomib)and immune modulators(Thalidomide,lenalidomide).No difference of the m OS between the 40 patients with 2-novel-drugs-based therapy(no transplantation)and the15 patients with allograft hematopoietic stem cell transplantation(P=0.204),but significantly better than the 29 patients(no transplantation)with onenovel-drug-based therapy(P<0.05).2)Prognostic factors for OS of 112 patients in univariate analysis subject: age,DS Ⅲ,renal function,ISS Ⅲ,IRPI 3,ECOG 4,E,Crea,Cys-C,ALP,TP,ALB,LDH,Fer,β2-MG(P<0.05).Independent factors multivariate analysis was:IRPI 3 and Cys-C(P<0.05).3)Prognostic factors for OS of 84 patients received more than 2 cycles therapies in univariate analysis showed: IRPI 3,ECOG 4,Crea,LDH,β2-MG and failure to achieve VGPR(P<0.05).Multivariate analysis showed that β 2-MG and failure to reach VGPR were independent risk factors(P<0.05).10.Death cause1)Septic shock and/or infection is the predominance death cause,32cases(76.19%).2)In 17 patients with survival time less than 3 months: median age was 72 years old(61.5-76.75),infectious shock death 9 cases(52.94%).Age,DS Ⅲ,renal function group B,ISS Ⅲ,IRPI 3,ECOG 4,E,Crea,Cys-C,ALP,LDH,Fer,β2-MG were related risk factors for survival.IRPI 3 and Cys-C were independent risk factorsConclusion:1.The number of NDMM in our hospital is increasing year by year.For some patients,the overall survival rate is low due to insufficient understanding of myeloma and limited treatment drugs in the early years.With the availability of new anti-myeloma drugs and the accumulation of clinical experience of doctors,the survival rate and long survival of patients were improved.2.The number of patients with SED in this group is relatively high,reducing SED requires early identification of MM by primary care physicians,and patients should be referred to hematology specialist for diagnosis and treatment.3.Constraction of score system for comorbidity,frailty,and activity of daily will help to decide precise individual therapy and improve survival status for the age,frail MM patients.4.Deficiencies of this study: single centra,bias of data missing,low number of the enrolled patients,et al. |
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