Undertreatment of Older Patients With Newly Diagnosed Multiple Myeloma in the Era of Novel Therapies.
Undertreatment of Older Patients With Newly Diagnosed Multiple Myeloma in the Era of Novel Therapies.
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DOI：
10.1016/j.clml.2018.01.005
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发表时间：
2018-03
期刊：
影响因子：
--
通讯作者：
Wildes TM
中科院分区：
文献类型：
--
作者：
Fakhri B;Fiala MA;Tuchman SA;Wildes TM
随着多发性骨髓瘤（MM）治疗药物的不断扩大，识别任何治疗不足的患者人群以减轻结局差异非常重要。我们提取了2007-2011年SEER-Medicare数据库中的所有浆细胞骨髓瘤病例（ICD-O-3代码9732）。ICD-0 -3组织学代码9732涵盖活动性MM和阴燃/无症状性骨髓瘤。我们将活动性MM定义为声明接受了批准的MM治疗或定义了临床特征的MM ICD-9代码（称为CRAB标准）。进行多变量逻辑回归以确定与未接受治疗独立相关的变量。在最初纳入研究的4，187例患者中，373例患者没有表明接受批准用于MM的治疗的声明，并且没有与CRAB标准相关的ICD-9代码，因此被排除在分析之外。在3，814例活动性MM患者中，1，445例（38%）没有任何声明证实他们接受了全身治疗。年龄较大，性能指标差，合并症，非洲裔美国人的种族，以及较低的社会经济地位（SES），包括参加医疗补助是统计学上显着的因素与接受无系统治疗。在这项SEER-医疗保险数据库的回顾性研究中，我们发现年龄，健康状况，种族和SES与接受MM治疗有关。这些因素以前与MM特定治疗（如干细胞移植）的利用率降低有关。然而，据我们所知，这是第一项显示其与接受任何MM治疗相关的研究。
With the expanding armamentarium of therapeutic agents in multiple myeloma (MM), it is important to identify any undertreated patient populations to mitigate outcome disparities. We extracted all plasma cell myeloma cases (ICD-O-3 code 9732) in the SEER-Medicare database from 2007–2011. The ICD-O-3 histology code 9732 captures both active MM and smoldering/asymptomatic myeloma. We defined active MM as either having claims indicating receipt of treatments approved for MM or ICD-9 codes for MM defining clinical features, referred to as CRAB criteria. Multivariate logistic regression was performed to determine the variables that were independently associated with receipt of no treatment. Of the initial 4,187 patients included in the study, 373 patients had no claims indicating receipt of treatments approved for MM and had no ICD-9 codes associated with CRAB criteria, and were excluded from the analyses. Among the 3,814 patients with active MM, 1,445 (38%) did not have any claims confirming that they received systemic treatment. Older age, poor performance indicators, comorbidities, African-American race, and a lower socioeconomic status (SES) including enrollment in Medicaid were statistically significant factors associated with receipt of no systemic treatment. In this retrospective study of the SEER-Medicare database, we found that age, health status, race, and SES were associated with receiving treatment for MM. These factors have previously been linked to reduced utilization of specific treatments for MM, such as stem cell transplants. To our knowledge, however, this is the first study to show their association with the receipt of any MM therapy.
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影响因子：
20.3
作者：
Griffiths, Robert;Mikhael, Joseph;Dreyling, Martin
通讯作者：
Dreyling, Martin
影响因子：
6.2
作者：
Fiala, Mark A.;Wildes, Tanya M.
通讯作者：
Wildes, Tanya M.
影响因子：
7.2
作者：
Klabunde, CN;Potosky, AL;Warren, JL
通讯作者：
Warren, JL
影响因子：
7.5
作者：
Costa, Luciano J.;Brill, Ilene K.;Brown, Elizabeth E.
通讯作者：
Brown, Elizabeth E.
影响因子：
2.8
作者：
Lambert M;Luke J;Downey B;Crengle S;Kelaher M;Reid S;Smylie J
通讯作者：
Smylie J