Цель. Анализ основных эпидемиологических показателей множественной миеломы (регистрируемая заболеваемость, распространенность, летальность, выживаемость) в крупном мегаполисе-г. Новосибирске (Сибирский федеральный округ). Материалы и методы. Объектом исследования служила медицинская документация 335 пациентов с впервые диагностированной множественной миеломой (ММ), наблюдавшихся с 1 января 2006 г. по 31 декабря 2016 г. в Городском гематологическом центре Новосибирска. Медиана возраста больных составила 67 лет (диапазон 30-89 лет), женщин было 218 (65 %), мужчин-117 (35 %). Результаты. Средняя регистрируемая заболеваемость ММ в Новосибирске за последние 10 лет увеличила сь в 1,6 раза, а распространенность-в 4,9. Эти показатели составили 2,4 и 13,8 случая на 100 000 населения в год соответственно с линейным трендом роста, что указывает не только на повышение числа пациентов с впервые диагностированной ММ, но и на увеличение продолжительности их жизни. Показатели заболеваемости и распространенности ММ статистически значимо выше среди женщин, чем мужчин, что, вероятнее всего, объясняется особенностями административных факторов региона. Ежегодная летальность больных ММ уменьшилась с 28,3 до 8,2 % с отрицательным линейным трендом на протяжении всего анализируемого периода, что, вероятнее всего, связано с возможностью использовать новые лекарственные средства и трансплантационные технологии. Заключение. Полученные эпидемиологические данные позволят планировать оказание своевременной и эффективной помощи пациентам с ММ, а также разработать систему обоснованного распределения дорогостоящего оборудования и лекарственных препаратов.

Aim. To study incidence and structure of comorbidity in multiple myeloma (MM) patients depending on their age; to determine its effect on overall survival, efficacy, and safety of the first-line therapy in real clinical practice. Materials & Methods. Overall, 369 patients with newly diagnosed MM were enrolled in the trial from January 2012 to December 2017. Among them there were 134 men and 235 women hospitalized at the Unit of Hematology in the Novosibirsk Municipal Clinical Hospital No. 2. Median age of patients was 67 years (range 32-82 years). Results. The analyzed patients were divided into three age groups: the first group of young/middle age (32-59 years) (n = 105), the second group of elderly patients (6074 years) (n = 186), and the third group of old age (> 75 years) (n = 78). In each patient prior to chemotherapy the comorbidity spectrum was identified and CIRS-G, CCI, and MCI comorbidity scores were calculated. Patients with newly diagnosed MM in real clinical practice prove to have high and increasing with age comorbidity incidence (91 % in patients of young/middle age, 97,7 % and 100 % in patients of elderly and old age, respectively). Comorbidity significantly reduces overall survival (OS) of MM patients. Important OS predictors are rhythm and conduction disorder (odds ratio, OR, 2.762; p < 0.002), chronic pancreatitis (OR 1.864; p < 0.001), exogenous constitutive obesity (OR 1.948; p < 0.002), chronic obstructive pulmonary disease (OR 2.105; p < 0.021), chronic kidney disease, stage С4-С5 (OR 2.255; p < 0.003), and chronic heart failure, functional class II (OR 1.915; p < 0.002). Highest importance in predicting OS, efficacy, and tolerance to chemotherapy in MM patients is attached to MCI score (OR 3.771; p < 0.001). MM patients with high risk by MCI are characterized by lower rate and depth of response to the first-line therapy, shorter time before the first relapse, higher incidence of non-hematologic toxicity of grade > 3, and therapy withdrawal or drug dose reduction.

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Introduction. Despite the availability and high effectiveness of modern anticancer drugs used to treat patients with multiple myeloma (MM), most patients inevitably develop disease relapses and refractoriness to the ongoing therapy. The prognosis in patients with relapsed MM and refractoriness to the main classes of anticancer drugs (proteasome inhibitors and immunomodulators) remains poor, and the median overall survival (OS) is only 8 months. Daratumumab is the first fully human IgG1-κ monoclonal antibody that binds with high affinity to the CD38 protein on the surface of myeloma cells, has a direct effect on the tumor, and also has an immunomodulatory mechanism of action. In clinical trials, daratumumab has been shown high effective and safety when used as monotherapy in patients with relapsed and double refractory MM. Aim. To evaluate the effectiveness and safety of daratumumab monotherapy in patients with relapsed/refractory multiple myeloma (RRMM) in real-life clinical practice. Materials and methods. We analyzed 32 patients with RRMM (14 men and 18 women) aged 41–76 years (median 65 years) from two hematological centers in the city of Novosibirsk. In 65.6% of patients, stage IIIA according to Durie-Salmon, stage I–II according to the ISS (in 65.6 and 28.1% of patients, respectively), ECOG performance status 0–1 (in 37.5 and 43.7% of patients, respectively) were diagnosed. Bone-related soft tissue plasmacytomas were recorded in 56.3% of patients, high lactate dehydrogenase activity was noted in 12 (37.5%) patients. The median number of prior lines of therapy was 2 (range 2–4). All patients had previously received proteasome inhibitors (bortezomib) and immunomodulatory agents (lenalidomide). Autologous hematopoietic stem cells transplantation was performed in 34.4% of patients. Double refractory MM was registered in 24 (75%) of 32 patients. The median time from diagnosis of MM to initiation of daratumumab therapy was 73.1 months (range 18–144 months). Daratumumab was administered as monotherapy at a dose of 16 mg/kg intravenously weekly (cycles 1–2), every other week (cycles 3–6), and then monthly. Results. The median duration of therapy with daratumumab was 12.2 months (range 4–22 months). The overall response rate (complete response + very good partial response (vgPR) + partial response (PR)) was 67.7%; vgPR – in 9 (29%) patients, PR – in 12 (38.7%), stable disease (SD) was registered in 19.4% of patients, respectively. The median time to response was 3.5 months (range 2.5–6). The median duration of response was 7.9 months (95% confidence interval (CI) 4.7–11.5). The median progression-free survival (PFS) was 19.1 months (95% CI 15.3–23.6), and the 12- and 18-month PFS were 91% and 50%, respectively. The median OS was not reached, and the 12- and 18-month OS values were 100% and 96.3%, respectively. The depth of the response had a statistically significant effect on the PFS (18-month PFS was 100% in the vgPR and PR subgroups and 81% in the SD subgroup, respectively (χ2 = 19.207, p < 0.001)). Therapy with daratumumab was accompanied with a favorable toxicity profile. In 37.5% of patients, grade 1 and 2 infusion reactions were noted, in 6.2% grade ≥ 3, in one patient, therapy was discontinued due to an infusion reaction of the 3rd degree. Fatigue, upper and lower respiratory tract infections (15.6% and 12.5%, respectively), anemia (15.6%), thrombocytopenia (6.2%), and neutropenia (6.2%) were recorded in 15.6% of patients. Conclusion. Therapy with daratumumab is an effective and safe treatment for RRMM.