Hacettepe Üniversitesi Hastanesinde Son Yirmi Yılda Takip Edilen Multipl Miyelom Hastalarında Sağkalımdaki Değişimin Değerlendirilmesi

Abstract

OZSAN S. Evaluation of the change in survival of multiple myeloma patients followed during the last twenty years at Hacettepe University Hospital, Hacettepe University Faculty of Medicine, Internal Medicine Specialty Thesis, Ankara, 2020 There have been many advances in multiple myeloma (MM) treatment over the past two decades. In this study, patients who had been followed in our center during last twenty years were examined in terms of survival. 309 patients who had been followed in our center for 20 years were evaluated retrospectively. The median age at diagnosis was 62 years, median overall survival time was 64.07 months in all patients. No clear prognosis improvement was observed over time in the entire cohort. However, survival in ISS stage 3 patients diagnosed in 2007 and before was worse than those diagnosed later. Age, International Staging System (ISS) stage, ECOG performance status, and presence of comorbidities at the time of diagnosis were evaluated as prognostic factors. Effect of treatment methods on survival was also evaluated. Impacts of availability of novel drugs at diagnosis and performing of autologous stem cell transplantation (ASCT) were determined. In univariate analyses, ISS staging, ECOG performance status, presence of comorbidities, age at diagnosis and ASCT were related to prognosis in all patients, while ISS staging and age at diagnosis retained their significance in multivariate analysis. Age is expected to effect prognosis both directly and by determining the treatment to be applied. ASCT is the cornerstone of MM treatment and is performed more frequently in the young age group. Therefore, the patients were divided into subgroups as young and old patient groups using 65 years as cut-off and parameters affecting prognosis were re-evaluated. In the elderly patient group, unlike the entire patient group, availability of novel treatment agents at the time of diagnosis seemed to affect prognosis. While ISS staging, ECOG performance evaluation, presence of comorbidities, ASCT and drug period were determined as related to prognosis in univariate analyses in this age group, no significant result was observed in multivariate analysis. In the young age group, while ISS staging and ASCT had impact on prognosis in univariate analyses, only ISS staging was determined significant in multivariate analysis. Before novel therapies came into use, the VAD (vincristine, adriamycin, dexamethasone) protocol had been used as induction therapy in MM. Recently, bortezomib-based treatments have been preferred for induction. It was also aimed to evaluate the effects of VAD protocol and bortezomib-based treatments as upfront treatment protocols on overall survival (OS) in patients who had undergone ASCT. Patients who received VAD versus bortezomib-based protocols as upfront induction therapy had significantly better OS. This unexpected finding should be confirmed in further studies.