骨髓瘤10年生存率是继续存活的门槛
编者按：这是来自于美国血液学会2003年年会的最新报告。
10-Year Survival in Myeloma: Have the Results Improved in the Last Decade?
Raymond Powles, B. Sirohi, S. Singhal, J. Treleaven, S. Kulkarni, C. Horton, C. Dearden, J. Mehta Myeloma unit, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
We have previously shown that patients with myeloma who survive longer than 10 y in first complete remission (CR) appear to be on a plateau of survival in which life span and quality of life are normal (Powles et al, Blood 2000: 96;2215a). Thus, focusing on 10-y survival data and measures to improve it may be a crucial end-point for long-term quality of life for myeloma patients. We have studied 167 new patients (median age 52 y, 30-68; 63F; 60% IgG; 81% stage III) with myeloma who were planned to receive infusional chemotherapy plus an autograft (70% received it) with minimum follow-up of 10-y (all diagnosed before 1993; analysis in 7/03). Median albumin was 35 g/L, B2M 3.9 mg/L, creatinine 92
mol/L. 10-y survival of these patients was 23%. For 10-y survival, B2M <3 mg/L (P=0.003) and age< 55 y (P=0.02) were the most significant variables predicting better outcome. Patients with pre-therapy B2M <3 and age < 55 y (n=39) had a 10-y survival of 43.4%. (median 9.1 y ) When these 167 were compared with 196 patients treated between 93-03, there was a significant OS advantage(P=0.0025) but as the follow-up of the latter group was shorter, we do not have 10-y follow-up on recent patients. To see whether we can use the minimum 5-y follow-up data to predict 10-y survival, we selected 2 cohorts of patients treated between 1988 -93 (n=118) and 1993-98 (n=100). The patients treated between 93-98 were significantly older (median 54 vs 52 y; P=0.01). Fig 1 shows that median OS of both groups of patients is identical (4.9 y) but patients in 88-93 group had a plateau of survival of 31% when analysed after 5-y of follow-up which dropped to 23% at 10-y follow-up. Patients in the more recent group have a 5-y survival of 39% which if it drops over the following 5 y at the same rate will end up with a 10-y survival of 29%. We have used our mainframe computer to analyze our 1988-93 cohort of patients in 1998 which gives them the same follow-up as is current for 1993-98 group. Fig 2 shows that more recently treated patients are faring better for OS at 10-y (P=0.055). This data shows that it may be possible to predict 10-y data with only 5-y of follow-up and if our improvement in 10-y OS is real in recently treated patients, its probably because of disciplined salvage treatment as the median OS has not changed.
Abstract #2553 appears in Blood, Volume 102, issue 11, November 16, 2003
Keywords: 10-y survival|Multiple Myeloma|Prediction, http://www.100md.com
10-Year Survival in Myeloma: Have the Results Improved in the Last Decade?
Raymond Powles, B. Sirohi, S. Singhal, J. Treleaven, S. Kulkarni, C. Horton, C. Dearden, J. Mehta Myeloma unit, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
We have previously shown that patients with myeloma who survive longer than 10 y in first complete remission (CR) appear to be on a plateau of survival in which life span and quality of life are normal (Powles et al, Blood 2000: 96;2215a). Thus, focusing on 10-y survival data and measures to improve it may be a crucial end-point for long-term quality of life for myeloma patients. We have studied 167 new patients (median age 52 y, 30-68; 63F; 60% IgG; 81% stage III) with myeloma who were planned to receive infusional chemotherapy plus an autograft (70% received it) with minimum follow-up of 10-y (all diagnosed before 1993; analysis in 7/03). Median albumin was 35 g/L, B2M 3.9 mg/L, creatinine 92
mol/L. 10-y survival of these patients was 23%. For 10-y survival, B2M <3 mg/L (P=0.003) and age< 55 y (P=0.02) were the most significant variables predicting better outcome. Patients with pre-therapy B2M <3 and age < 55 y (n=39) had a 10-y survival of 43.4%. (median 9.1 y ) When these 167 were compared with 196 patients treated between 93-03, there was a significant OS advantage(P=0.0025) but as the follow-up of the latter group was shorter, we do not have 10-y follow-up on recent patients. To see whether we can use the minimum 5-y follow-up data to predict 10-y survival, we selected 2 cohorts of patients treated between 1988 -93 (n=118) and 1993-98 (n=100). The patients treated between 93-98 were significantly older (median 54 vs 52 y; P=0.01). Fig 1 shows that median OS of both groups of patients is identical (4.9 y) but patients in 88-93 group had a plateau of survival of 31% when analysed after 5-y of follow-up which dropped to 23% at 10-y follow-up. Patients in the more recent group have a 5-y survival of 39% which if it drops over the following 5 y at the same rate will end up with a 10-y survival of 29%. We have used our mainframe computer to analyze our 1988-93 cohort of patients in 1998 which gives them the same follow-up as is current for 1993-98 group. Fig 2 shows that more recently treated patients are faring better for OS at 10-y (P=0.055). This data shows that it may be possible to predict 10-y data with only 5-y of follow-up and if our improvement in 10-y OS is real in recently treated patients, its probably because of disciplined salvage treatment as the median OS has not changed.Abstract #2553 appears in Blood, Volume 102, issue 11, November 16, 2003
Keywords: 10-y survival|Multiple Myeloma|Prediction, http://www.100md.com