初诊多发性骨髓瘤合并骨髓纤维化患者临床特征及预后分析  

Analysis of clinical and prognostic characteristics of newly diagnosed multiple myeloma with myelofibrosis patients

作　　者：张磊 李玉龙 刘益民 刘渊博 商保军 程薇 董晓燕 朱尊民 Zhang Lei;Li Yulong;Liu Yimin;Liu Yuanbo;Shang Baojun;Cheng Wei;Dong Xiaoyan;Zhu Zunmin(Hematological Institute of Henan Provincial People′s Hospital,Henan Provincial Key Laboratory of Hematopathology,CAR-T Cell Therapy and Transformation Engineering Research Center of Henan Province,People′s Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院血液病研究所,河南省血液病理重点实验室河南省,CAR‑T细胞治疗与转化工程研究中心,郑州大学人民医院血液病研究所,郑州450003

出　　处：《中华医学杂志》2024年第1期57-62,共6页National Medical Journal of China

基　　金：河南省医学科技攻关项目(LHGJ20220011);河南省医学教育研究项目(Wjlx2022014)

摘　　要：目的探讨初诊多发性骨髓瘤(NDMM)合并骨髓纤维化(MF)患者的临床特征及预后。方法回顾性分析2012年1月至2022年7月河南省人民医院收治的160例NDMM患者临床资料,根据是否合并MF分为MF组(n=74)及非MF组(n=86)。MF组进一步分为MF-1级组(n=47)和MF-2/3级组(n=27)。所有患者均采用以硼替佐米和免疫调节剂为基础的联合治疗方案,4个疗程后进行疗效评估,比较两组间的临床特征及预后。随访日期截至2022年12月30日,随访时间[M(Q_(1),Q_(3))]为23.5(14.4,40.5)个月。采用Kaplan-Meier法进行生存分析,生存率影响因素分析采用Cox风险回归模型。结果160例NDMM患者中,男91例,女69例,年龄[M(Q_(1),Q_(3))]为59(54,69)岁。MF组骨髓原/幼浆细胞、总浆细胞比例分别为9.6%(3.2%,28.5%)、36.4%(18.5%,51.1%),均高于非MF组的6.0%(1.2%,17.2%)、24.0%(12.0%,46.0%)(均P<0.05);MF组血红蛋白(Hb)为84.0(74.5,100.5)g/L,血小板(PLT)为(151.99±90.68)×10^(9)/L,均低于非MF组的96.0(81.0,112.0)g/L及(180.38±85.32)×10^(9)/L(均P<0.05),但两组患者国际分期系统(ISS)分期、染色体核型分析、荧光原位杂交(FISH)高危遗传学异常差异均无统计学意义(均P>0.05)。两组间治疗客观缓解率(ORR)、总生存期(OS)及无进展生存期(PFS)差异均无统计学意义(均P>0.05)。MF-2/3级组患者17p-阳性率为25.9%(7/27),高于非MF组的8.1%(7/86)(P=0.049)。MF-2/3级组中位OS为25.0(95%CI:23.6~26.4)个月,短于非MF组的54.0个月(P=0.031)。多因素Cox回归分析显示,MF-2/3级不是影响NDMM患者OS的危险因素(HR=1.507,95%CI:0.624~3.993,P=0.425)。结论合并MF的NDMM患者骨髓原/幼浆细胞、总浆细胞比例高于未合并MF患者,Hb、PLT低于未合并MF患者。合并2/3级MF的NDMM患者较未合并MF患者生存期短。Objective To investigate the clinical and prognostic characteristics of newly diagnosed multiple myeloma(NDMM)patients with myelofibrosis(MF).Methods The clinical data of 160 NDMM patients admitted to Henan Provincial People′s Hospital from January 2012 to July 2022 were analyzed retrospectively.They were divided into MF group(n=74)and non-MF group(n=86)according to whether combined with MF.Patients in MF group were further splited into MF-1 group(n=47)and MF-2/3 group(n=27).All patients were treated with bortezomib and immunomodulatory-based combination therapy.The efficacy was evaluated after 4 courses,and the clinical features and prognosis between the two groups were compared.The deadline for follow-up was December 30,2022 and the median follow-up period[M(Q_(1),Q_(3))]was 23.5(14.4,40.5)months.Kaplan-Meier method was used for survival analysis,and Cox regression model was used to analyze the influencing factors of survival.Results Among 160 patients with NDMM,91 were males and 69 were females,with a median age[M(Q_(1),Q_(3))]of 59(54,69)years.In MF group,the bone marrow immature plasma cell percentage,total plasma cell percentage were 9.6%(3.2%,28.5%)and 36.4%(18.5%,51.1%),respectively,which were higher than 6.0%(1.2%,17.2%)and 24.0%(12.0%,46.0%)of the non-MF group(both P<0.05).Hb level was 84.0(74.5,100.5)g/L and PLT was(151.99±90.68)×10^(9)/L in the MF group,which were lower than 96.0(81.0,112.0)g/L and(180.38±85.32)×10^(9)/L of non-MF group(both P<0.05).But there were no significant differences in ISS stage,karyotypic and fluorescence in situ hybridization(FISH)high-risk genetic abnormalities between the two groups(all P>0.05).Objective response rate(ORR),overall survival(OS)and progression-free survival(PFS)were not significantly different between the two groups(all P>0.05).The rate of 17p-was 25.9%(7/27)in MF-2/3 group,which was higher than 8.1%(7/86)of non-MF group(P=0.049).The median OS of the MF-2/3 group was 25.0(95%CI:23.6-26.4)months,which was shorter than that of the non-MF group(54.0 month

关 键 词：多发性骨髓瘤 骨髓纤维化 生物学特征 预后 荧光原位杂交 

分 类 号：R733.3[医药卫生—肿瘤] R551.3[医药卫生—临床医学]