高风险骨髓瘤具有异质性，风险分层存在显着差异。现实世界的结果与对照临床试验不同，并受到社会经济决定因素的影响。这项回顾性研究是在印度北部的一家三级护理癌症医院进行的。对 384,76（19.7%）名高危骨髓瘤患者（中位年龄 58 岁）进行了分析。最常见的 HRCA 是 1 q Gain 36（47.4%），其次是 del17p 32（42.1%）。 61/76（80.2%）接受基于硼替佐米的三胞胎诱导，15（19.74%）基于达雷妥尤单抗的四胞胎诱导，31（40.79%）接受ASCT。中位随访时间为 19.5 个月。 2 年 OS 和 PFS 分别为 73.8%、52.6%。 ASCT 队列的估计 3 年 OS 为 74.7%，而无 ASCT 队列的 3 年 OS 为 52.9% (P = .0067)。 ASCT 队列中估计的 3 年 PFS 为 72.1%，而未进行 ASCT 队列的 3 年 PFS 为 30.3% (P = .0026)。单次命中和多次命中超 HRMM 的估计 3 年 OS 分别为 67.7% 和 61.9% (P = .642)，而 PFS 分别为 58.2% 和 35.2% (P = .486)。在多变量分析中，ASCT 与更好的 OS（HR 0.3，P = .041）和 PFS（HR 0.35，P = .012）相关。不存在基线肾功能损害仅与更好的 OS 相关（HR 4.12，P = .004）。早期积极治疗和及时 ASCT 可以转化为高危骨髓瘤患者更好的生存率。强调现实世界的临床结果是解决实际问题和改善全球骨髓瘤结果的迫切需要。版权所有 © 2024 Elsevier Inc. 保留所有权利。

High risk myeloma is heterogeneous with significant variation in risk stratifications. Real world outcomes differ from controlled clinical trials and affected by socioeconomical determinants.This retrospective study was performed in a North Indian teriarty care cancer hospital. Out of 384,76(19.7%) high risk myeloma patients (median age 58 years) were analyzed.Most common HRCA was 1 q gain 36(47.4%) followed by del17p 32(42.1%). 61/76(80.2%) received bortezomib based triplets and 15(19.74%) daratumumab based quadruplets induction, 31(40.79%) received ASCT. Median duration of follow up was 19.5 months. The 2 year OS and PFS was 73.8%, 52.6% respectively. Estimated 3 year OS was 74.7% in ASCT cohort versus 52.9% (P = .0067) without. Estimated 3-year PFS in the ASCT cohort was 72.1% versus 30.3% (P = .0026) without. Estimated 3-year OS for single hit and multi hit ultra HRMM was 67.7% and 61.9% (P = .642) whereas PFS was 58.2% and 35.2% (P = .486) respectively. In multivariate analysis ASCT correlated with better OS (HR 0.3, P = .041) and PFS (HR 0.35, P = .012). Absence of baseline renal impairment correlated with better OS (HR 4.12, P = .004) only. Early aggressive therapy with prompt ASCT translates to a better survival in high risk myeloma. Emphasis on real world clinical outcome is the need of the hour for addressing practical issues and improving global myeloma outcome.Copyright © 2024 Elsevier Inc. All rights reserved.