初诊伴髓外病变的多发性骨髓瘤患者的临床特征及预后分析  

Clinical features and prognostic analysis of newly diagnosed multiple myeloma with extramedullary disease

作　　者：付庆华 夏冰 杨洪亮 许雯 赵海丰 于泳 赵智刚 王亚非 王晓芳 FU Qing-hua;XIA Bing;YANG Hong-liang;XU Wen;ZHAO Hai-feng;YU Yong;ZHAO Zhi-gang;WANG Ya-fei;WANG Xiao-fang(Department of Hematology,Tianjin Medical University Cancer Institute and Hospital,National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy,Tianjin,Tianjin’s Clinical Research Center for Cancer,Tianjin 300060,China)

机构地区：[1]天津医科大学肿瘤医院血液科,国家肿瘤临床医学研究中心,天津市"肿瘤防治"重点实验室,天津市恶性肿瘤临床医学研究中心,300060

出　　处：《天津医药》2020年第5期415-420,共6页Tianjin Medical Journal

摘　　要：目的分析初诊伴不同类型髓外病变(EMD)的多发性骨髓瘤(MM)患者临床特征及对预后的影响。方法回顾性分析本院收治资料完整的99例初诊伴EMD的MM患者在性别、年龄、免疫球蛋白类型、DS分期、ISS分期等临床特征上的异同,对不同髓外病变类型的患者进行生存及预后分析并探究不同治疗方案的预后意义。结果伴骨旁髓外病变(b EMD,57例)与非骨旁髓外病变(sEMD,42例)的MM患者之间临床特征差异无统计学意义(P>0.05)。2种最多见髓外病变部位分别为肋骨(42.1%)及软组织(50.0%)。bEMD组和sEMD组中位总生存期(OS,45个月vs.15个月)、中位无进展生存期(PFS,20个月vs.10个月)差异均有统计学意义(P<0.05)。年龄≥60岁(HR=2.333,95%CI:1.025~5.309,P<0.05)、β2-MG≥2.7 mg/L(HR=4.361,95%CI:1.304~14.587,P<0.05)及TP53突变(HR=3.697,95%CI:1.015~13.469,P<0.05)为影响EMD患者OS的独立预后因素。sEMD组含硼替佐米诱导化疗后序贯ASCT的患者中位PFS(49个月vs.9个月,P<0.05)和中位OS(79个月vs.12个月,P<0.05)与化疗后未行自体造血干细胞移植患者相比具有统计学意义。结论伴sEMD的MM患者预后较bEMD差,含硼替佐米化疗序贯自体造血干细胞移植有可能会延长伴sEMD患者生存,改善预后。ObjectiveTo analyze the clinical characteristics and prognosis of newly diagnosed multiple myeloma(MM)patients with different types of extramedullary disease(EMD).MethodsData of gender,age,immunoglobulin type,DSstage,ISS stage and other clinical characteristics of 99 MM patients with EMD who were admitted to our hospital and hadcomplete clinical data were retrospectively analyzed.The survival analysis and prognostic analysis on patients with differenttypes of extramedullary diseases were performed,and the prognostic significance of different therapeutic regimens wasexplored.ResultsThere were no significant differences in clinical characteristics between MM patients with the bone-related EMD(b EMD,n=57)and strict EMD(s EMD,n=42,P>0.05).The two types of extramedullary diseases were mainlyfound in ribs(42.1%)and soft tissues(50.0%)respectively.There were significant differences in median OS time(45 monthsvs.15 months,P<0.05)and median PFS(20 months vs.10 months,P<0.05)between b EMD group and s EMD group.It wasfound that age≥60 years(HR=2.333,95%CI:1.025-5.309,P<0.05),β2-MG≥2.7 mg/L(HR=4.361,95%CI:1.304-14.587,P<0.05)and mutation of TP53(HR=3.697,95%CI:1.015-13.469,P<0.05)were independent prognostic factors affectingOS in EMD patients.The median PFS(49 months vs.9 months,P<0.05)and median OS(79 months vs.12 months,P<0.05)of patients with sequential ASCT after bortezomi-induced chemotherapy in the s EMD group were statistically significantcompared with those without ASCT.ConclusionThe prognosis of MM patients with s EMD is worse than that of b EMDpatients.The sequential autologous hematopoietic stem cell transplantation with bortezomib chemotherapy may prolong the survival and improve prognosis of patients with sEMD.

关 键 词：多发性骨髓瘤 硼酸化物 造血干细胞移植 预后 髓外病变 硼替佐米 

分 类 号：R733.3[医药卫生—肿瘤]