硼替佐米治疗伴P53缺失的双打击多发性骨髓瘤患者的疗效及预后分析  

Clinical Efficacy and Prognosis of Double-Hit Multiple Myeloma Patients with Deletion P53 Treated with Regimen Based on Bortezomib

作　　者：王东梅[1] 陈园园[1] 孟真[1] 张永晓[1] 郭素青[1] 李英华[1] WANG Dong-Mei;CHEN Yuan-Yuan;MENG Zhen;ZHANG Yong-Xiao;GUO Su-Qing;LI Ying-Hua(Department of Hematology,Harrison International Peace Hospital,Hengshui 053000,Hebei Province,China)

机构地区：[1]哈励逊国际和平医院血液科,河北衡水053000

出　　处：《中国实验血液学杂志》2020年第4期1221-1227,共7页Journal of Experimental Hematology

基　　金：衡水市科学技术研究与发展计划项目(2016014097Z)。

摘　　要：目的:探讨硼替佐米治疗伴P53缺失的双打击多发性骨髓瘤(MM)患者的疗效及预后。方法:回顾性分析2012年1月至2019年1月在哈励逊国际和平医院住院的新发MM骨髓瘤患者的临床资料;用G显带技术和原位荧光杂交方法(FISH)检测患者染色体核型和基因(P53缺失、1q21扩增、IgH重排)情况;对MM患者采用以硼替佐米为主的化疗方案治疗4个疗程后,分析伴P53缺失的双打击多发性骨髓瘤患者的疗效和远期生存情况。结果:186例MM患者中,检出单纯P53缺失者14例,合并1q21扩增者(A组)11例,合并t(14;16)者(B组)7例,合并t(4;14)者(C组)9例。伴有P53缺失的27例双打击多发性骨髓瘤患者均可以评价,3组的完全缓解率(CR%)分别为27.27%、28.57%和33.33%,总有效率(ORR%)分别为54.54%、57.14%和55.56%,均无统计学差异(P>0.05)。3组患者的总生存期分别为26.15±12.53、36.57±16.80和33.56±15.99个月,无事件生存期分别为22.82±12.71、29.79±14.25和24.97±13.95个月,均具有统计学差异(P=0.041,P=0.046)。伴1q21扩增的双打击骨髓瘤患者的总生存期较仅P53缺失的MM患者明显缩短(P=0.027),无事件生存期较仅P53缺失的MM患者也缩短,但无统计学差异(P=0.157);伴t(14;16)和伴t(4;14)的双打击骨髓瘤患者的总生存期较仅P53缺失的MM患者缩短,但无统计学差异(P=0.871,P=0.276),无事件生存期较仅P53缺失的MM患者亦缩短,均无统计学差异(P=0.955,P=0.379)。结论:P53缺失合并1q21扩增的双打击骨髓瘤更容易早期复发,患者总生存期短,预后差,是对MM患者预后有重要影响的遗传学指标。Objective:To investigate the clinical efficacy and prognosis of double-hit multiple myeloma patients with deletion P53 treated with regimen based on bortezomib.Methods:The ethnical data from 186 newly diagnosed MM patients hospitalized in the Department of Hematology of Harrison International Peace hospital from January 2012 to January 2019 were analyzed retrospectively.The fluorescent in situ hybridization(FISH)and G-binding staining were used to detect cytogenetic abnormalities(P53 deletion,lq21 amplification and IgH rearranagement)for analyses of complete remission(CR),overall response rate(ORR),progression-free survival(PFS)and overall survival(OS)of patients treated with bortezomib for 4 circles.Results:In 186 patients,simple P53 deletion was 14 cases,1q21 amplification and P53 deletion were found in 11 cases(A group),t(14;16)and P53 deletion in 7 cases(B group),t(4;14)and P53 deletion in 9 cases(C group).The complete remission rate(CR%)of above-mentioned three groups was 27.27%,28.57%and 33.33%respectively,and the ORR of the three groups was 54.54%,57.14%and 55.56%,respectively,there was no statistically significant difference between the three groups(P>0.05).The patients with 1 q21 amplification and P53 deletion had shorter OS and PFS time(P=0.041,P=0.046).The double-hit patients with 1q21 amplification showed shorter OS time,compared with the patients with P53 deletion(P=0.027).The double-hit patients with t(14;16)and t(4;14)showed shorter OS time(P=0.871,P=0.276)and PFS time(P=0.955,P=0.379)than those of the patients with P53 deletion.Conclusion:P53 deletion and 1q21 amplification are an adverse prognostic factor of early recurrence and short lifetime in patients with newly diagnosed double-hit MM.

关 键 词：多发性骨髓瘤 硼替佐米 P53缺失 化疗 

分 类 号：R733.3[医药卫生—肿瘤]