来那度胺长期维持治疗对多发性骨髓瘤患者的临床疗效和预后评估  

Evaluation of the Clinical Efficacy and Prognosis of Long-Term Maintenance Lenalidomide Therapy in Patients with Multiple Myeloma

作　　者：罗曼[1] 胡莉文[1] 古学奎[1] 蓝海[2] LUO Man;HU Li-Wen;GU Xue-Kui;LAN Hai(Department of Hematology,The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong Province,China;Department of Oncology,Shunde Hospital,Guangzhou University of Chinese Medicine,Shunde 528333,Guangdong Province,China)

机构地区：[1]广州中医药大学第一附属医院血液科,广东广州510405 [2]广州中医药大学顺德医院肿瘤科,广东顺德528333

出　　处：《中国实验血液学杂志》2021年第2期540-546,共7页Journal of Experimental Hematology

摘　　要：目的:研究多发性骨髓瘤(MM)患者接受来那度胺长期维持治疗的临床疗效及预后评估。方法:选择广州中医药大学第一附属医院血液科2012年-2019年确诊为MM的患者97例,检测并评估其基本临床特征和实验室检查指标。对MM患者进行来那度胺长期维持治疗后,评估其短期和长期临床疗效以及不良反应发生率,并分析影响患者预后的相关因素。结果:维持治疗前,47.42%的患者(46/97)未达到完全缓解(CR),52.58%(51/97)达CR的患者中20.62%的患者为微小残留白血病阴性(MRD^(-))。来那度胺维持治疗后,未达到CR患者降低至24.74%(24/97),75.26%(73/97)达CR的患者中47.42%的患者为MRD^(-),差异具有统计学意义(P<0.001)。维持治疗后,患者的中位无进展生存期为58个月,5年生存率达89.69%。不良反应发生率为40.21%(39/97),主要表现为中性粒细胞减少(31/39,79.49%)、疲乏(21/39,53.85%)、血小板减少(17/39,43.59%)、胃肠道反应(15/39,38.46%)。停药率为24.74%(24/97),停药的中位时间为21个月,停药原因主要是中性粒细胞减少症(12/24,50.00%)、血小板减少(8/24,33.33%)和胃肠道反应(2/24,8.33%)。高龄和MRD阳性为影响患者预后的危险因素,调整后OR分别为1.43(95%CI 1.03-1.76,P=0.034)和3.78(95%CI 2.56-9.56,P=0.037)。结论:来那度胺长期维持治疗对MM患者有良好的临床疗效,且MRD检测可辅助临床判断患者预后。维持治疗过程中需注意监控患者的临床症状,尤其是血液系统损害,避免严重不良反应的发生。Objective:To investigate the clinical efficacy and prognosis of patients with multiple myeloma(MM)treated by long-term maintenance lenalidomide treatment.Methods:A total of 97 patients diagnosed as MM in the Department of Hematology of First Affiliated Hospital of Guangzhou University of Chinese Medicine from 2012 to 2019 were selected,and the basic clinical characteristics and laboratory indicators of the patients were tested and evaluated.After long-term maintenance lenalidomide treatment for patients with MM,the short-term and long-term clinical efficacy and the incidence of adverse reactions were evaluated,and factors affecting the prognosis of the patients were analyzed.Results:Before maintenance treatment,47.42%of the patients(46/97)did not achieve complete remission(CR),among 52.58%(51/97)of CR patients,there were 20.62%of the patients showed minimal residual leukemia(MRD)negative.After lenalidomide maintenance treatment,the patients who did not achieve CR were reduced to 24.74%(24/97),among 75.26%(73/97)of the patients with CR,there were 47.42%of the patients showed MRD negative,the difference showed statistically significant(P<0.001).After maintenance treatment,the median progression-free survival of the patients was 58 months,and the 5-year survival rate was 89.69%.The incidence of adverse reactions was 40.21%(39/97),including neutropenia(31/39,79.49%),fatigue(21/39,53.85%),thrombocytopenia(17/39,43.59%)and gastrointestinal reaction(15/39,38.46%)were the most common.The discontinuation rate was24.74%(24/97),and the median time for discontinuation was 21 months.The main reasons for discontinuation were neutropenia(12/24,50.00%),thrombocytopenia(8/24,33.33%)and gastrointestinal reactions accounted for8.33%(2/24).Old age and positive MRD were the risk factors affecting the prognosis of the patients.The adjusted OR was 1.43(95%CI 1.03-1.76,P=0.034)and 3.78(95%CI 2.56-9.56,P=0.037),respectively.Conclusion:The long-term maintenance lenalidomide treatment shows a good clinical effect on patients with MM,and MR

关 键 词：来那度胺 维持治疗 多发性骨髓瘤 临床效果 预后评估 

分 类 号：R733.3[医药卫生—肿瘤]