Diagnosis and treatment of multiple myeloma in Hunan Province.
10.11817/j.issn.1672-7347.2022.210555
- Author:
Feiyang LIU
1
;
Qian CHENG
2
;
Kui SONG
3
;
Huan YU
4
;
Junjun LI
5
;
Hui ZHANG
6
;
Guoyu HU
7
;
Ming ZHOU
8
;
Jun WANG
9
;
Zhongqi DING
10
;
Zimian LUO
11
;
Ting PENG
12
;
Liang DING
12
;
Liang ZHAO
13
;
Jing LIU
14
;
Yanjuan HE
15
;
Hongling PENG
16
Author Information
1. Department of Hematology, Third Xiangya Hospital, Central South University, Changsha 410013. 546917399@qq.com.
2. Department of Hematology, Third Xiangya Hospital, Central South University, Changsha 410013. chengqian222222@126.com.
3. Department of Hematology, Xiangxi Autonomous Prefecture People's Hospital, Jishou Hunan 416007.
4. Department of Hematology, First People's Hospital of Chenzhou, Chenzhou Hunan 423000.
5. Department of Hematology, First Affiliated Hospital of University of South China, Hengyang Hunan 421001.
6. Department of Hematology-Oncology, Central Hospital of Shaoyang, Shaoyang Hunan 422099.
7. Department of Hematology, Central Hospital of Zhuzhou, Zhuzhou Hunan 412007.
8. Department of Hematology, First Affiliated Hospital of Hunan Normal University, Changsha 410005.
9. Department of Hematology, First People's Hospital of Changde City, Changde Hunan 415003.
10. Department of Hematology, First People's Hospital of Huaihua, Huaihua Hunan 418099.
11. Department of Hematology, Central Hospital of Xiangtan, Xiangtan Hunan 411199.
12. Department of Hematology, Third Xiangya Hospital, Central South University, Changsha 410013.
13. Department of Hematology, Xiangya Hospital, Central South University, Changsha 410008.
14. Department of Hematology, Third Xiangya Hospital, Central South University, Changsha 410013. jingliu0318@aliyun.com.
15. Department of Hematology, Xiangya Hospital, Central South University, Changsha 410008. 15973130688@163.com.
16. Department of Hematology, Second Xiangya Hospital, Central South University, Changsha 410011, China. penghongling@csu.edu.cn.
- Publication Type:Journal Article
- Keywords:
multicenter study;
multiple myeloma;
real world study
- MeSH:
Antineoplastic Combined Chemotherapy Protocols/therapeutic use*;
Female;
Humans;
Immunologic Factors/therapeutic use*;
Male;
Middle Aged;
Multiple Myeloma/therapy*;
Neoplasm Staging;
Pain;
Prognosis;
Proteasome Inhibitors/therapeutic use*
- From:
Journal of Central South University(Medical Sciences)
2022;47(4):497-504
- CountryChina
- Language:English
-
Abstract:
OBJECTIVES:There is less clinical data on multiple myeloma (MM) in China, and the aim of this study was to collect and analyze the clinical data of newly diagnosed multiple myeloma (NDMM) patients in Hunan Province during 1 year, to understand the real clinical features and treatment outcome for Hunan Province patients with MM, and to strengthen the understanding of the standardized diagnosis process and treatment plan of MM.
METHODS:The clinical data of 529 patients with NDMM in 12 large-scale general hospitals in Hunan Province from January 1 to December 31, 2019 were collected and analyzed, including baseline data, treatment regimens, duration of treatment, and adverse reactions. The clinical characteristics, treatment, and safety of patients were analyzed by SPSS 21.0.
RESULTS:Among the 529 NDMM patients, the age was 33-90 (median 64) years and the male-female ratio was 1.38꞉1. The clinical features ranged from high to low were as follows: Bone pain (77.7%), anemia (66.8%), renal insufficiency (40.6%), hypercalcemia (15.1%). Typing: IgG 46.5%, IgA 24.6%, IgD 2.6%, IgM 0.8%, light chain 15.7%, double clone 3.0%, no secretion 0.6%, absence 6.2%. Staging: Durie-Salmon stage I, II, and III were 4.5%, 10.6%, 77.3%, respectively, and 40 cases (7.6%) missed this data. International Staging System (ISS) stage I, II, and III were 10.4%, 24.4%, and 47.6%, respectively, and 93 cases (17.6%) were missing. Revised International Staging System (R-ISS) stage I, II, and III were 5.5%, 27.0%, 23.1%, respectively, and 235 cases (44.4%) missed this data. Among the 98 NDMM patients in the Third Xiangya Hospital, Central South University, Durie-Salmon (DS) stage missing 2.0%, ISS stage missing 12.3%, and R-ISS stage missing 12.3%.Treatment: Among the 529 patients,475 received treatment, the rate of treatment was 89.8%; 67.4% of the patients were able to complete four courses of chemotherapy at induction phase, 90.3% of the patients received proteasome inhibitor based combination chemotherapy regimen more than once, 67.2% received immunomodulator based regimen more than once, and 59.8% of the patients received proteasome inhibitor and immunomodulator based combination chemotherapy regimen more than once. Curative: Overall response rate (ORR) and high quality response rate (HQR) of the 4-course group were better than those of the 2-course group (ORR: 85% vs 65%, P=0.006; HQR: 68.3% vs 24.0%, P<0.001). The HQR of the standard chemotherapy group was better than that of the non-standard chemotherapy group (65.1% vs 48.2%, P=0.035). Adverse reactions during treatment included hematologic toxicity (17.5%), peripheral neuropathy (24.8%), gastrointestinal adverse events (23.8%), pulmonary infection (25.9%), herpes zoster (4.6%), and venous thrombotic events (1.7%).
CONCLUSIONS:In 2019, the missed diagnosis rate of MM patients was high, the medium age of diagnosis was older, and the accuracy of patient diagnosis was not high. There is a great difference among medical centers, especially in the stage and risk stratified, nearly half of NDMM patients are not diagnosed with R-ISS stage; the lack of cytogenetic data needs to be supplemented by follow-up studies. A high proportion of patients with NDMM present with bone pain and anemia.Patients received treatment have higher use of chemotherapy regimens containing proteasome inhibitors and/or immunomodulators, but there is a significant gap among different medical centers, and standardized treatment needs to be strengthened. The safety during chemotherapy is controllable.
