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目的:运用Frailty评分体系预测老年多发性骨髓瘤(multiple myeloma,MM)患者临床转归的研究分析。方法:对复旦大学附属中山医院血液科2015年1月1日至2016年2月29日收治的29例65岁以上老年MM患者进行Frailty评分,以分析其与患者临床转归的关系。结果:Frailty评分高危组13例(44.8%)、中危组5例(17.2%)、低危组11例(37.9%),3组患者在ISS分期(P=0.281)和化疗强度(P=0.475)上的差异无统计学意义。Frailty高危组患者不良反应较多,血液学3级及以上不良发生率(69.2%)显著高于低危组(18.2%,P=0.014)和中危组(0.0,P=0.011);高危组非血液学3级及以上不良反应发生率(84.6%)显著高于低危组(18.2%,P=0.001)和中危组(20.0%,P=0.011)。高危组中有69.2%的患者中断、延缓化疗或减小化疗强度,显著高于低危组(9.1%,P=0.004),与中危组差异无统计学意义(40.0%,P=0.268)。高危组患者化疗后获完全缓解(CR)及极好的部分缓解(VGPR)的患者占30.8%、部分缓解(PR)者占23.1%、无效(NR)者占46.2%,显著低于低危组(CR及VGPR 63.6%、PR 36.4%、NR 0.0,P=0.027),与中危组比较差异无统计学意义(CR及VGPR 40.0%、PR20.0%、NR 40.0%,P=0.751)。结论:Frailty评分体系可预测高危患者治疗的不良反应和疗效,高危患者预后差,但其对预后评估价值的大小有待更大样本量的阐明。
OBJECTIVE: To evaluate the clinical outcomes of multiple myeloma (MM) using Frailty scoring system. Methods: 29 Frailty elderly patients over 65 years old admitted to Department of Hematology, Zhongshan Hospital, Fudan University from January 1, 2015 to February 29, 2016 were assessed with Frailty to analyze their relationship with clinical outcome. Results: Frailty score was high risk in 13 cases (44.8%), moderate risk group in 5 cases (17.2%) and low risk group in 11 cases (37.9%). The ISI stage (P = 0.281) and chemotherapy intensity 0.475) the difference was not statistically significant. Adverse reactions were more common in the Frailty high-risk group than those in the low-risk group (18.2%, P = 0.014) and moderate-risk group (0.0%, P = 0.011) The incidence of grade 3 and above non-hematological malignancies (84.6%) was significantly higher than that in low-risk group (18.2%, P = 0.001) and moderate-risk group (20.0%, P = 0.011). 69.2% of patients in high-risk group were interrupted, delayed chemotherapy or decreased the intensity of chemotherapy, which was significantly higher than that in low-risk group (9.1%, P = 0.004). There was no significant difference between high risk group and intermediate risk group (40.0%, P = 0.268) . Patients in the high-risk group had 30.8% of patients with complete remission (CR) and excellent partial response (VGPR) after chemotherapy, 23.1% of patients with partial remission (PR) and 46.2% of patients with ineffective (NR), significantly lower than those with low risk (CR and VGPR of 63.6%, PR 36.4%, NR 0.0, P = 0.027). There was no significant difference between the two groups (CR and VGPR 40.0%, PR20.0%, NR 40.0%, P = 0.751) . Conclusion: Frailty scoring system can predict the adverse reactions and the curative effects of high-risk patients. The prognosis of high-risk patients is poor, but the value of the prognostic value remains to be elucidated in larger sample size.