СРАВНИТЕЛЬНЫЙ АНАЛИЗ ИНДЕКСОВ КОМОРБИДНОСТИ ПРИ МНОЖЕСТВЕННОЙ МИЕЛОМЕ
Аннотация
Проведен ретроспективный анализ историй болезни 206 больных ММ, наблюдавшихся в гематологическом отделении Городского гематологического центра г. Новосибирска с 2006 по 2016 год. Медиана возраста группе пациентов моложе 65 лет составила 56,6 лет (от 29 до 64 лет) и 70,2 года (от 65 до 82) в группе пожилых больных. У каждого пациента был определен спектр сопутствующих заболеваний на момент начала терапии и рассчитаны индивидуальные индексы коморбидности по шкалам CIRS-G, M. Charlson и Fraiburg. Анализ полученных данных показал, что коморбидность имеет значение в прогнозировании ОВ у больных с ММ. Из изучаемых индексов коморбидности наибольшее значение в прогнозировании выживаемости имеет индекс Fraiburg (HR – 3,870, р<0,003), так как все составляющие его факторы, такие как СКФ≤30мл/мин/1,73m2 (HR-1,910 (95%ДИ 1,217-3,415) p<0,014), общее состояние по шкале Карновского ≤ 70 (HR-1,863 (95%ДИ 1,267-2,845) p<0,003), умеренная или тяжелая обструктивная болезнь легких (HR-1,845 (95% ДИ 1,165 – 3,235) p<0,004), показали существенное влияние на ОВ больных ММ. Индексы CIRS-G и M. Charlson не имели самостоятельного прогностического значения при ММ в рутинной клинической практике. Регрессионный анализ Кокса показал, что из всех сопутствующих заболеваний, входящих в состав CIRS-G (14 органов и систем) и M. Charlson (19 сопутствующих заболеваний), только нарушение ритма и проводимости (HR-1,580, p<0,003), хронический панкреатит (HR-2,210, p<0,013) и ожирение (HR-1,783, p<0,042) являются существенными факторами, влияющими на ОВ у больных ММ.
Литература
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3. Waxman A.J., Mink P.J., Devesa S.S., et al. Racial disparities in incidence and outcome in multiple myeloma: apopulation-based study. // Blood. 2010. Vol. 116 (25). P. 5501–5506. DOI: 10.1182/ blood-2010-07-298760.
4. Crusoe Ede Q., da Silva A.M., Agareno J., et al. Multiple myeloma: a rare case in an 8-year-old child. // Clin Lymphoma Myeloma Leuk. 2015. Vol. 15(1). P. e31–e3. DOI: 10.1016/j. clml.2014.08.004.
5. Kristinsson S.Y., Landgren O., Dickman P.W., Derolf A.R., Björkholm M. Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. // J Clin Oncol. 2007. Vol. 25(15). P. 1993-1999.
6. Brenner H., Gondos A., Pulte D. Recent major improvements in long-term survival of younger patients with multiple myeloma. // Blood. 2008. Vol. 111(5). P. 2521-2526.
7. Schaapveld M., Visser O., Siesling S., et al. Improved survival among younger but not among older patients with multiple myeloma in the Netherlands, a population-based study since 1989. // Eur J Cancer. 2010. Vol. 46(1). P. 160-169.
8. Kumar S.K., Rajkumar S.V., Dispenzieri A., et al. Improved survival in multiple myeloma and the impact of novel therapies. // Blood. 2008. Vol. 111(5). P. 2516-2520.
9. Altekruse S.F., Kosary C.L., Krapcho M., et al., editors. SEER Cancer Statistics Review. Bethesda, MD: National Cancer Institute; 1975-2007. http://seer.cancer.gov/csr/1975_2007/, based on November 2009 SEER data submission, posted to the SEER Web site 2010.
10. Kristinsson S.Y., Landgren O., Dickman P.W., et al. Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. // J Clin Oncol. 2007. Vol. 25(15). P. 1993-1999.
11. Brenner H., Gondos A., Pulte D. Recent major improvements in long-term survival of younger patients with multiple myeloma. // Blood. 2008. Vol. 111(5). P. 2521-2526.
12. Hallek M., Fischer K., Fingerle-Rowson G., et al. Addition of rituximab to fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a randomised, open-label, phase 3 trial. // The Lancet. 2010. Vol. 376(9747). P. 1164–74. DOI: 10.1016/S0140-6736(10)61381-5.
13. Yancik R. Cancer burden in the aged: an epidemiologic and demographic overview. // Cancer. 1997. Vol. 80(7). P. 1273–83. DOI: 10.1002/(sici)10970142(19971001)80:7<1273::aid-cncr13>3.0.co;2-4.
14. Kleber M., Ihorst G., Terhorst M., et al. Comorbidity as a prognostic variable in multiple myeloma: comparative evaluation of common comorbidity scores and use of a novel MM–comorbidity score. // Blood Cancer J. 2011. Vol. 1(9). P. e35.
15. Sung Min Kim, Moon Jin Kim, Hyun Ae Jung, et al. Comparison of the Freiburg and Charlson Comorbidity Indices in Predicting Overall Survival in Elderly Patients with Newly Diagnosed Multiple Myeloma. // Biomed Res Int. 2014. Vol. 2014. P. 437852.
16. Caughey G.E., Ramsay E.N., Vitry A.I., et al. Comorbid chronic diseases, discordant impact on mortality in older people: a 14-year longitudinal population study // J. Epidemiol Community Health. 2010. Vol. 64(12). P. 1036-1042.
17. Sorror M.L., Maris M.B., Storb R., et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. // Blood. 2005. Vol. 106. P. 2912–2919.
18. Charlson M.E., Pompei P., Ales K.L., MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. // J Chronic Dis. 1987. Vol. 40. P. 373-383.
19. Kaplan M.H., Feinstein A.R. The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. // J Chronic Dis. 1974. Vol. 27. P. 387–404.
20. Satariano W.A., Ragland D.R. The effect of comorbidity on 3-year survival of women with primary breast cancer. // Ann Intern Med. 1994. Vol. 120. P. 104–110.
21. Miller M., Towers A. A manual of guidelines for scoring the cumulative illness rating scale for geriatrics (CIRS-G). May 1991. Available from:http://www.anq.ch/fileadmin/redaktion/deutsch/20121211_CIRSG_Manual_E. pdf. (accessed 12.04.2016).
REFERENCES
1. Mendeleeva L.P., Votyakova O.M. O.S., et al. National clinical guidelines for the diagnosis and treatment of multiple myeloma. // Gematologiya i transfuziologiy = Hematology and Transfusiology. 2016. Vol. 61 (1, Suppl. 2). P. 1–24 (in Russisn). DOI: 10.18821/0234-5730-2016-61-1.
2. Kyle R.A., Rajkumar S.V. Epidemiology of the plasma-cell disorders. // Best Pract Res Clin Haematol. 2007. Vol. 20(4). P. 637–64. DOI:10.1016/j.beha.2007.08.001.
3. Waxman A.J., Mink P.J., Devesa S.S., et al. Racial disparities in incidence and outcome in multiple myeloma: apopulation-based study. // Blood. 2010. Vol. 116 (25). P. 5501–5506. DOI: 10.1182/ blood-2010-07-298760.
4. Crusoe Ede Q., da Silva A.M., Agareno J., et al. Multiple myeloma: a rare case in an 8-year-old child. // Clin Lymphoma Myeloma Leuk. 2015. Vol. 15(1). P. e31–e3. DOI: 10.1016/j. clml.2014.08.004.
5. Kristinsson S.Y., Landgren O., Dickman P.W., Derolf A.R., Björkholm M. Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. // J Clin Oncol. 2007. Vol. 25(15). P. 1993-1999.
6. Brenner H., Gondos A., Pulte D. Recent major improvements in long-term survival of younger patients with multiple myeloma. // Blood. 2008. Vol. 111(5). P. 2521-2526.
7. Schaapveld M., Visser O., Siesling S., et al. Improved survival among younger but not among older patients with multiple myeloma in the Netherlands, a population-based study since 1989. // Eur J Cancer. 2010. Vol. 46(1). P. 160-169.
8. Kumar S.K., Rajkumar S.V., Dispenzieri A., et al. Improved survival in multiple myeloma and the impact of novel therapies. // Blood. 2008. Vol. 111(5). P. 2516-2520.
9. Altekruse S.F., Kosary C.L., Krapcho M., et al., editors. SEER Cancer Statistics Review. Bethesda, MD: National Cancer Institute; 1975-2007. http://seer.cancer.gov/csr/1975_2007/, based on November 2009 SEER data submission, posted to the SEER Web site 2010.
10. Kristinsson S.Y., Landgren O., Dickman P.W., et al. Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. // J Clin Oncol. 2007. Vol. 25(15). P. 1993-1999.
11. Brenner H., Gondos A., Pulte D. Recent major improvements in long-term survival of younger patients with multiple myeloma. // Blood. 2008. Vol. 111(5). P. 2521-2526.
12. Hallek M., Fischer K., Fingerle-Rowson G., et al. Addition of rituximab to fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a randomised, open-label, phase 3 trial. // The Lancet. 2010. Vol. 376(9747). P. 1164–74. DOI: 10.1016/S0140-6736(10)61381-5.
13. Yancik R. Cancer burden in the aged: an epidemiologic and demographic overview. // Cancer. 1997. Vol. 80(7). P. 1273–83. DOI: 10.1002/(sici)10970142(19971001)80:7<1273::aid-cncr13>3.0.co;2-4.
14. Kleber M., Ihorst G., Terhorst M., et al. Comorbidity as a prognostic variable in multiple myeloma: comparative evaluation of common comorbidity scores and use of a novel MM–comorbidity score. // Blood Cancer J. 2011. Vol. 1(9). P. e35.
15. Sung Min Kim, Moon Jin Kim, Hyun Ae Jung, et al. Comparison of the Freiburg and Charlson Comorbidity Indices in Predicting Overall Survival in Elderly Patients with Newly Diagnosed Multiple Myeloma. // Biomed Res Int. 2014. Vol. 2014. P. 437852.
16. Caughey G.E., Ramsay E.N., Vitry A.I., et al. Comorbid chronic diseases, discordant impact on mortality in older people: a 14-year longitudinal population study // J. Epidemiol Community Health. 2010. Vol. 64(12). P. 1036-1042.
17. Sorror M.L., Maris M.B., Storb R., et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. // Blood. 2005. Vol. 106. P. 2912–2919.
18. Charlson M.E., Pompei P., Ales K.L., MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. // J Chronic Dis. 1987. Vol. 40. P. 373-383.
19. Kaplan M.H., Feinstein A.R. The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. // J Chronic Dis. 1974. Vol. 27. P. 387–404.
20. Satariano W.A., Ragland D.R. The effect of comorbidity on 3-year survival of women with primary breast cancer. // Ann Intern Med. 1994. Vol. 120. P. 104–110.
21. Miller M., Towers A. A manual of guidelines for scoring the cumulative illness rating scale for geriatrics (CIRS-G). May 1991. Available from:http://www.anq.ch/fileadmin/redaktion/deutsch/20121211_CIRSG_Manual_E. pdf. (accessed 12.04.2016).
2. Kyle R.A., Rajkumar S.V. Epidemiology of the plasma-cell disorders. // Best Pract Res Clin Haematol. 2007. Vol. 20(4). P. 637–64. DOI:10.1016/j.beha.2007.08.001.
3. Waxman A.J., Mink P.J., Devesa S.S., et al. Racial disparities in incidence and outcome in multiple myeloma: apopulation-based study. // Blood. 2010. Vol. 116 (25). P. 5501–5506. DOI: 10.1182/ blood-2010-07-298760.
4. Crusoe Ede Q., da Silva A.M., Agareno J., et al. Multiple myeloma: a rare case in an 8-year-old child. // Clin Lymphoma Myeloma Leuk. 2015. Vol. 15(1). P. e31–e3. DOI: 10.1016/j. clml.2014.08.004.
5. Kristinsson S.Y., Landgren O., Dickman P.W., Derolf A.R., Björkholm M. Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. // J Clin Oncol. 2007. Vol. 25(15). P. 1993-1999.
6. Brenner H., Gondos A., Pulte D. Recent major improvements in long-term survival of younger patients with multiple myeloma. // Blood. 2008. Vol. 111(5). P. 2521-2526.
7. Schaapveld M., Visser O., Siesling S., et al. Improved survival among younger but not among older patients with multiple myeloma in the Netherlands, a population-based study since 1989. // Eur J Cancer. 2010. Vol. 46(1). P. 160-169.
8. Kumar S.K., Rajkumar S.V., Dispenzieri A., et al. Improved survival in multiple myeloma and the impact of novel therapies. // Blood. 2008. Vol. 111(5). P. 2516-2520.
9. Altekruse S.F., Kosary C.L., Krapcho M., et al., editors. SEER Cancer Statistics Review. Bethesda, MD: National Cancer Institute; 1975-2007. http://seer.cancer.gov/csr/1975_2007/, based on November 2009 SEER data submission, posted to the SEER Web site 2010.
10. Kristinsson S.Y., Landgren O., Dickman P.W., et al. Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. // J Clin Oncol. 2007. Vol. 25(15). P. 1993-1999.
11. Brenner H., Gondos A., Pulte D. Recent major improvements in long-term survival of younger patients with multiple myeloma. // Blood. 2008. Vol. 111(5). P. 2521-2526.
12. Hallek M., Fischer K., Fingerle-Rowson G., et al. Addition of rituximab to fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a randomised, open-label, phase 3 trial. // The Lancet. 2010. Vol. 376(9747). P. 1164–74. DOI: 10.1016/S0140-6736(10)61381-5.
13. Yancik R. Cancer burden in the aged: an epidemiologic and demographic overview. // Cancer. 1997. Vol. 80(7). P. 1273–83. DOI: 10.1002/(sici)10970142(19971001)80:7<1273::aid-cncr13>3.0.co;2-4.
14. Kleber M., Ihorst G., Terhorst M., et al. Comorbidity as a prognostic variable in multiple myeloma: comparative evaluation of common comorbidity scores and use of a novel MM–comorbidity score. // Blood Cancer J. 2011. Vol. 1(9). P. e35.
15. Sung Min Kim, Moon Jin Kim, Hyun Ae Jung, et al. Comparison of the Freiburg and Charlson Comorbidity Indices in Predicting Overall Survival in Elderly Patients with Newly Diagnosed Multiple Myeloma. // Biomed Res Int. 2014. Vol. 2014. P. 437852.
16. Caughey G.E., Ramsay E.N., Vitry A.I., et al. Comorbid chronic diseases, discordant impact on mortality in older people: a 14-year longitudinal population study // J. Epidemiol Community Health. 2010. Vol. 64(12). P. 1036-1042.
17. Sorror M.L., Maris M.B., Storb R., et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. // Blood. 2005. Vol. 106. P. 2912–2919.
18. Charlson M.E., Pompei P., Ales K.L., MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. // J Chronic Dis. 1987. Vol. 40. P. 373-383.
19. Kaplan M.H., Feinstein A.R. The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. // J Chronic Dis. 1974. Vol. 27. P. 387–404.
20. Satariano W.A., Ragland D.R. The effect of comorbidity on 3-year survival of women with primary breast cancer. // Ann Intern Med. 1994. Vol. 120. P. 104–110.
21. Miller M., Towers A. A manual of guidelines for scoring the cumulative illness rating scale for geriatrics (CIRS-G). May 1991. Available from:http://www.anq.ch/fileadmin/redaktion/deutsch/20121211_CIRSG_Manual_E. pdf. (accessed 12.04.2016).
REFERENCES
1. Mendeleeva L.P., Votyakova O.M. O.S., et al. National clinical guidelines for the diagnosis and treatment of multiple myeloma. // Gematologiya i transfuziologiy = Hematology and Transfusiology. 2016. Vol. 61 (1, Suppl. 2). P. 1–24 (in Russisn). DOI: 10.18821/0234-5730-2016-61-1.
2. Kyle R.A., Rajkumar S.V. Epidemiology of the plasma-cell disorders. // Best Pract Res Clin Haematol. 2007. Vol. 20(4). P. 637–64. DOI:10.1016/j.beha.2007.08.001.
3. Waxman A.J., Mink P.J., Devesa S.S., et al. Racial disparities in incidence and outcome in multiple myeloma: apopulation-based study. // Blood. 2010. Vol. 116 (25). P. 5501–5506. DOI: 10.1182/ blood-2010-07-298760.
4. Crusoe Ede Q., da Silva A.M., Agareno J., et al. Multiple myeloma: a rare case in an 8-year-old child. // Clin Lymphoma Myeloma Leuk. 2015. Vol. 15(1). P. e31–e3. DOI: 10.1016/j. clml.2014.08.004.
5. Kristinsson S.Y., Landgren O., Dickman P.W., Derolf A.R., Björkholm M. Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. // J Clin Oncol. 2007. Vol. 25(15). P. 1993-1999.
6. Brenner H., Gondos A., Pulte D. Recent major improvements in long-term survival of younger patients with multiple myeloma. // Blood. 2008. Vol. 111(5). P. 2521-2526.
7. Schaapveld M., Visser O., Siesling S., et al. Improved survival among younger but not among older patients with multiple myeloma in the Netherlands, a population-based study since 1989. // Eur J Cancer. 2010. Vol. 46(1). P. 160-169.
8. Kumar S.K., Rajkumar S.V., Dispenzieri A., et al. Improved survival in multiple myeloma and the impact of novel therapies. // Blood. 2008. Vol. 111(5). P. 2516-2520.
9. Altekruse S.F., Kosary C.L., Krapcho M., et al., editors. SEER Cancer Statistics Review. Bethesda, MD: National Cancer Institute; 1975-2007. http://seer.cancer.gov/csr/1975_2007/, based on November 2009 SEER data submission, posted to the SEER Web site 2010.
10. Kristinsson S.Y., Landgren O., Dickman P.W., et al. Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. // J Clin Oncol. 2007. Vol. 25(15). P. 1993-1999.
11. Brenner H., Gondos A., Pulte D. Recent major improvements in long-term survival of younger patients with multiple myeloma. // Blood. 2008. Vol. 111(5). P. 2521-2526.
12. Hallek M., Fischer K., Fingerle-Rowson G., et al. Addition of rituximab to fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a randomised, open-label, phase 3 trial. // The Lancet. 2010. Vol. 376(9747). P. 1164–74. DOI: 10.1016/S0140-6736(10)61381-5.
13. Yancik R. Cancer burden in the aged: an epidemiologic and demographic overview. // Cancer. 1997. Vol. 80(7). P. 1273–83. DOI: 10.1002/(sici)10970142(19971001)80:7<1273::aid-cncr13>3.0.co;2-4.
14. Kleber M., Ihorst G., Terhorst M., et al. Comorbidity as a prognostic variable in multiple myeloma: comparative evaluation of common comorbidity scores and use of a novel MM–comorbidity score. // Blood Cancer J. 2011. Vol. 1(9). P. e35.
15. Sung Min Kim, Moon Jin Kim, Hyun Ae Jung, et al. Comparison of the Freiburg and Charlson Comorbidity Indices in Predicting Overall Survival in Elderly Patients with Newly Diagnosed Multiple Myeloma. // Biomed Res Int. 2014. Vol. 2014. P. 437852.
16. Caughey G.E., Ramsay E.N., Vitry A.I., et al. Comorbid chronic diseases, discordant impact on mortality in older people: a 14-year longitudinal population study // J. Epidemiol Community Health. 2010. Vol. 64(12). P. 1036-1042.
17. Sorror M.L., Maris M.B., Storb R., et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. // Blood. 2005. Vol. 106. P. 2912–2919.
18. Charlson M.E., Pompei P., Ales K.L., MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. // J Chronic Dis. 1987. Vol. 40. P. 373-383.
19. Kaplan M.H., Feinstein A.R. The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. // J Chronic Dis. 1974. Vol. 27. P. 387–404.
20. Satariano W.A., Ragland D.R. The effect of comorbidity on 3-year survival of women with primary breast cancer. // Ann Intern Med. 1994. Vol. 120. P. 104–110.
21. Miller M., Towers A. A manual of guidelines for scoring the cumulative illness rating scale for geriatrics (CIRS-G). May 1991. Available from:http://www.anq.ch/fileadmin/redaktion/deutsch/20121211_CIRSG_Manual_E. pdf. (accessed 12.04.2016).
Опубликована
2019-01-20
Как цитировать
СКВОРЦОВА, Наталия Валерьевна et al.
СРАВНИТЕЛЬНЫЙ АНАЛИЗ ИНДЕКСОВ КОМОРБИДНОСТИ ПРИ МНОЖЕСТВЕННОЙ МИЕЛОМЕ.
Сибирский медицинский журнал (Иркутск) 16+, [S.l.], v. 153, n. 2, p. 29-36, янв. 2019.
ISSN 1815-7572. Доступно на: <http://smj.ismu.baikal.ru/index.php/osn/article/view/290>. Дата доступа: 04 фев. 2025
Выпуск
Раздел
Оригинальные исследования
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