多发性骨髓瘤是一种高度异质性的浆细胞恶性肿瘤，常见于老年患者。年龄是重要的预后因素之一。然而，几乎所有预后评估系统都是基于临床试验，其中患者相对健康年轻。目前尚不清楚生化或细胞遗传学预后因素的存在及其风险权重如何随着年龄增长而变化。为进一步探究这个问题，我们回顾性分析了一个连续队列的患者数据，这些患者接受了波替尼或沙利度胺为基础的治疗。本回顾性研究纳入了1125例初诊多发性骨髓瘤患者的队列，时间为2008年1月至2019年12月。患者接受了波替尼或沙利度胺为基础的诱导和维持治疗，如符合条件，患者也接受了造血干细胞移植。统计分析采用Stata/MP 16.0和SPSS 26.0软件进行。随着年龄的增加，患者中ISS 3级、活动能力状态评分≥2级以及1q增益的发生率显著增加。我们还发现ISS在年龄较大的患者中变得不那么重要。然而，细胞遗传学异常对年轻和老年患者的生存都产生了持续不利的影响。老年患者的预后不如年轻患者。我们队列中的所有患者除71岁及以上的患者外，都比沙利度胺为基础的诱导治疗获益更多。ISS可能在71岁及以上的患者中失去预后价值。老年患者的预后较差，需要更有效且毒副作用更少的治疗。 简介 多发性骨髓瘤是一种血液癌症，常见于老年人。治疗这种疾病，主要困难有基因异常、患者身体状态较差以及肿瘤细胞的大量存在。我们通常是从临床试验中得出这些结论。然而，临床试验总是招募相对年轻的患者，因此这些因素的存在和重要性可能因临床试验与真实世界的差异而有所不同。我们进行了这项研究，以找出年轻和老年患者的实际风险。我们发现老年患者更容易出现贫血、营养状况差和肾功能损伤。我们还发现老年患者的复发、进展或死亡风险比年轻患者更高。虚弱的身体状况是治疗老年患者的主要障碍，而肿瘤负担不再影响这些人的预后。波替尼是治疗这种疾病的有效药物，但71岁及以上的患者的受益较小。更多的研究应该关注老年或虚弱患者，因为这些患者需要更有效且毒副作用更少的治疗。

Multiple myeloma is a highly heterogenous plasma cell malignancy, commonly seen in older patients. Age is one of the important prognostic factors. However, nearly all the prognostic staging systems are based on clinical trials, where patients were relatively fit and young. It is unknown how the presence of biochemical or cytogenetic prognostic factors and their risk weights changes with older age. To further investigate this question, we retrospectively analyzed the data from a consecutive cohort of patients treated with either bortezomib or thalidomide-based therapy.This retrospective study was carried out on a cohort of 1125 newly diagnosed multiple myeloma patients, from January 2008 to December 2019. Patients received bortezomib or thalidomide-based induction and maintenance therapy. Patients accepted hematopoietic stem cell transplantation if eligible. Statistical analysis was conducted by Stata/MP 16.0 and SPSS 26.0.With age increasing, the proportion of patients with ISS 3, performance status score ≥2, and the incidence rate of gain(1q) significantly increased. We also found that ISS became less important in older patients. However, cytogenetic abnormalities exerted a consistently adverse impact on survival, both in young and old patients. Older patients had an inferior outcome than their young counterparts. All patients in our cohort benefitted more from bortezomib than thalidomide-based induction therapy, except for patients ≥71 years old.ISS may lose prognostic value in patients ≥71 years old. Older patients had an inferior outcome and needed more effective and less toxic treatment.Plain Language SummaryMultiple myeloma is a type of blood cancer commonly seen in older people. To treat this disease, genetic abnormality, the poor physical status of patients and the abundance of tumor cells are the main difficulties. We often draw these conclusions from clinical trials. However, clinical trials always enrolled relatively younger patients, so the presence and significance of these factors may vary from clinical trials to the real world. We conducted the study to find out the real risk in both young and old patients. We found that older patients were more likely to have anemia, poor nutritional status and renal function. We also found older patients had more risk of relapse, progression or death than young patients. Frail physical status is the key obstacle to treating older patients, and tumor burden no longer impacts the outcome of these people. Bortezomib is a powerful drug to treat this disease, but patients ≥71 years old had less benefit than younger ones. More studies should focus on older or frail patients as these patients need more effective and less toxic treatment.