尽管多发性骨髓瘤的新疗法的可及性和使用率增加，但早期死亡对于老年患者来说是一个普遍的挑战，对其产生显著影响。文献中报告的早期死亡率和预测因素各不相同，大多数研究很少关注社区治疗患者。本研究回顾性地分析了一个实际电子健康记录派生去标识化数据库中7512名在2011年1月1日至2021年2月2日期间新诊断的多发性骨髓瘤患者，这些患者主要在美国社区肿瘤诊所接受治疗，使用二元 logistic 回归方法研究了早期死亡（多发性骨髓瘤诊断后6个月内死亡）相关的因素。总体中位数年龄为70岁。我们发现早期死亡率总体为8.3％，其中73％发生在年龄≥70岁的患者中。在早期死亡中，只有49名患者（8.7％）死亡前有记录的疾病进展（中位时间为30天[四分位距，7-53天]）。与早期死亡风险增加相关的基线因素包括东方协作肿瘤组织绩效状态（ECOG PS）≥2、修订的国际分期系统（R-ISS）III期、年龄≥70岁、接受蛋白酶体抑制剂双联疗法、轻链型、以及肾功能异常（估计的肾小球滤过率<30毫升/分钟）。在年龄≥70岁的患者中，ECOG PS≥2和R-ISS III期仍然是早期死亡的最强预测因子。早期死亡不均影响着年龄较大的患者（年龄≥70岁）患上多发性骨髓瘤。需要采取干预措施支持这一人群，以降低不同的生存结果。本研究评估了7512名主要进行社区治疗的多发性骨髓瘤患者中，死亡率最高的风险因素——在新诊断多发性骨髓瘤（MM）后6个月内死亡（早期死亡）的危险因素。早期死亡率为8.3％；在这些死亡病例中，有49名患者（8.7％）死亡前有多发性骨髓瘤进展的记录。早期死亡的风险在年龄较大的患者（年龄≥70岁）和表现状态差、肾功能差、疾病分期较高、轻链多发性骨髓瘤和接受双联疗法的患者中最大。这些发现强调了面向多发性骨髓瘤老年患者的支持干预措施的必要性。©2023美国癌症学会。

Despite the increased availability and use of novel therapies for multiple myeloma, early mortality is a pervasive challenge with a significant impact on older adults. Reported rates and predictors of early mortality have varied in the literature, with most studies seldom focusing on community-treated patients.In this retrospective cohort analysis of a real-world electronic health record-derived deidentified database of 7512 patients newly diagnosed with multiple myeloma between January 1, 2011, and February 2, 2021, and treated primarily in US-based community oncology practices, factors associated with early mortality (defined as death within 6 months after the multiple myeloma diagnosis) were examined with the use of binary logistic regression.The median age was 70 years overall. We found an overall early mortality rate of 8.3%, with 73% of early deaths occurring in those aged ≥70 years. Among the early deaths, only 49 patients (8.7%) had documented disease progression before death (median time to progression, 30 days [interquartile range, 7-53 days]). Baseline factors associated with higher odds of early mortality included an Eastern Cooperative Oncology Group performance status (ECOG PS) ≥ 2, Revised International Staging System (R-ISS) stage III, an age ≥ 70 years, receipt of proteasome inhibitor-doublet therapy, a light-chain isotype, and the presence of renal dysfunction (estimated glomerular filtration rate < 30 mL/min). Among those aged ≥70 years, ECOG PS ≥ 2 and R-ISS stage III remained the strongest predictors of early mortality.Early mortality disproportionately affects older adults (aged ≥70 years) with multiple myeloma. Interventions to support this population are needed to reduce disparate survival outcomes.Factors associated with an increased risk of dying within 6 months (early mortality) of a new diagnosis of multiple myeloma (MM) among 7512 mostly community-treated patients with MM were evaluated. The early mortality rate was 8.3%; among those deaths, 49 patients (8.7%) had documented evidence of MM progression before death. The risk of early mortality was greatest for older patients (aged ≥70 years) and those with a poor performance status, poor kidney function, a higher disease stage, and light-chain MM and those receiving two-drug MM therapies. These findings highlight the need for supportive interventions geared toward older adults with MM.© 2023 American Cancer Society.