多发性骨髓瘤继发第二肿瘤临床研究  

Association of multiple myeloma and second primary malignancy

作　　者：付丽娜[1] 陆敏秋[1] 褚彬[1] 石磊[1] 邱爽[1] 吴俊[1] 鲍立[1] 

机构地区：[1]北京积水潭医院血液科,北京100096

出　　处：《临床军医杂志》2017年第12期1264-1266,1269,共4页Clinical Journal of Medical Officers

基　　金：北京市自然科学基金资助项目(7162080)

摘　　要：目的探讨多发性骨髓瘤(MM)继发第二肿瘤患者的临床特点及预后。方法回顾性分析北京积水潭医院血液科自2005年1月至2016月12月收治的280例初诊MM患者的临床资料,从中检索MM继发第二肿瘤的患者,并对MM继发第二肿瘤患者的临床表现、诊疗过程及预后因素进行分析。结果对280例连续诊治的MM患者进行随访,中位随访时间为34个月,继发浆细胞白血病患者4例,发病率为1.4%(4/280);继发浆细胞白血病患者的中位发病年龄为65岁,总中位生存期为37个月,确诊继发浆细胞白血病后,患者的中位生存时间为3.5个月。出现继发第二肿瘤患者5例,发病率为1.8%(5/280);MM继发第二肿瘤患者的中位发病年龄为59岁,总生存期为19~135个月,中位生存为42个月。继发第二肿瘤的类型分别为肺癌1例,膀胱癌1例,急性髓系白血病1例,弥漫大B细胞淋巴瘤2例。其中,血液系统肿瘤占60.0%(3/5)。初始治疗方案包括烷化剂、免疫调节剂及硼替佐米。治疗后完全缓解患者3例(60.0%)。MM患者、MM继发第二肿瘤患者的中位生存时间比较,差异无统计学意义(P>0.05)。MM继发第二肿瘤患者的中位生存时间较MM继发浆细胞白血病的长,差异有统计学意义(P<0.05)。结论 MM继发第二肿瘤的患者预后差,生存期缩短,且MM继发第二肿瘤后患者的中位生存时间较MM继发浆细胞白血病后患者的中位生存时间延长。Objective To investigate the clinical characteristics and prognostic factors of patients with multiple myeloma（ MM） and following second primary malignancy（ SPM）. Methods A retrospective study was performed on 280 cases of MM patients who were admitted from January 2005 to December 2016. The cases of SPM were selected,the clinical manifestations,diagnosis,treatment process and prognostic factors were analyzed. Results The 280 cases were continuously followed up,the median following-up time was37 months,4 cases of secondary plasma cell leukemia（ s PCL） were observed,the morbidity was 1. 4%（ 4/280）; the mean age of patients with s PCL was 65 years,the overall survival time was 37 months,the median survival time was 3. 5 months after diagnosis of MM with s PCL. Five cases of SPM were observed,the morbidity was 1. 8%（ 5/280）; the mean age of patients with SPM was 59 years,the overall survival time was 19 to 135 months,median survival time was 42 months. The subtype were lung cancer（ n = 1）,bladder cancer（ n = 1）,acute myeloid leukemia（ n = 1）,diffuse large B cell lymphoma（ n = 2）,60. 0%（ 3/5） were hematological malignant tumor. Initial treatment regimens included alkylation agents,immunological regulator and bortezomib. Three patients（ 60. 0%） were completely relieved after treatment. The median survival time between MM patients and MM patients with SPM had no statistically significant difference（ P〈0. 05）. The median survival time of MM patients with SPM was longer than that of MM patients with s PCL,and the difference was statistically significant（ P〈0. 05）. Conclusion The prognosis is bad,overall survival time is short and the median overall survival time is extended in MM patients with SPM compared to the MM patients with secondary plasma cell leukemia.

关 键 词：多发性骨髓瘤 第二肿瘤 浆细胞白血病 预后 

分 类 号：R733.71[医药卫生—肿瘤]