染色体1q21扩增对多发性骨髓瘤预后及治疗效果的影响  

Impact of 1q21 amplification on prognosis and treatment effect of multiple myeloma

作　　者：张佳佳[1] 陈世伦[1] 李新[1] 申曼[1] 黄仲夏[1] 钟玉萍[1] 

机构地区：[1]首都医科大学附属北京朝阳医院京西院区血液科 北京市多发性骨髓瘤医疗研究中心,100043

出　　处：《白血病．淋巴瘤》2015年第3期184-187,共4页Journal of Leukemia & Lymphoma

摘　　要：目的 探讨1q21扩增在新诊断的多发性骨髓瘤（MM）患者中对治疗效果的影响和预后价值.方法 收集2008年6月至2010年6月收治的52例初治MM患者,利用荧光原位杂交（FISH）技术对其进行1q21扩增的检测,并分析其与患者临床特征、疗效及预后的关系.结果 在52例初治MM患者中,30例（57.7％）伴有1q21扩增,其临床特征（性别、恶性胸腔积液、髓外浆细胞瘤、骨质破坏、β 2-微球蛋白、清蛋白、血红蛋白、血钙、浆细胞数、分型及临床分期等）与不伴有1q21扩增的患者比较,差异均无统计学意义（均P＞ 0.05）.52例患者被分为1q21扩增组（30例）和1q21未扩增组（22例）,分别接受4个疗程硼替佐米联合地塞米松方案化疗,两组治疗总有效率差异无统计学意义[80.0％（24/30）比81.8％（18/22）,P＞ 0.05].扩增组与未扩增组中位总生存期分别为26个月（6～50个月）和30个月（12～ 85个月）,差异无统计学意义（P=0.409）;两组中位无进展生存期分别为8个月（1～31个月）和20个月（3～ 48个月）,差异有统计学意义（P=0.019）.多因素分析结果显示,纳入因素中仅含1q21扩增同时伴有2个以上的复杂染色体核型是疗效的独立影响因素（P=0.031）.结论 1q21扩增是影响MM患者的一个不良预后因素,1q21扩增阳性的患者接受硼替佐米的治疗效果与阴性的患者无明显差异.但1q21扩增阳性患者的中位PFS较阴性患者明显缩短,复发较快.Objective To investigate the value of 1q21 amplification in newly diagnosed myeloma patients.Methods Fifty-two cases of newly diagnosed multiple myeloma from June 2008 to June 2010 were enrolled.Fluorescence in situ hybridization （FISH） was used to detect the 1q21 amplification,and the clinical characteristics and treatment response were analyzed.Results 1q21 amplification was discovered in 30 of 52 patients （57.7 %）,Clinical characteristics such as gender,malignant pleural effusion,extramedullary plasmacytoma,bone destruction,β2 microglobulin,ALB,hemoglobin,blood calcium,plasma cell proportion,clinical stage seemed to have no correlation with 1q21 amplification.The 52 patients all received bortezomibbased regimens.The response rates were not significant difference between patients with and without 1q21 amplification,the OS was also not significant difference [26 months （6-30 months） vs 30 months （12-85 months）,P =0.409],but the patients with presence of 1q21 gain resulted in significantly shorter PFS [8 months （1-30 months） vs 20 months （3--48 months）,P=0.019].Multivariate analysis showed 1q21 with more than two additional genetic abnormalities was an independent prognostic predictor （P =0.031）.Conclusion 1q21 amplification is one of the adverse prognostic predictors,the response rate is not significant difference between patients with and without 1q21 amplification in bortezomib-based group,but the 1q21 amplification could result in significantly shortened PFS.

关 键 词：多发性骨髓瘤 染色体1q21扩增 预后 

分 类 号：R733.3[医药卫生—肿瘤]