双打击型高危多发性骨髓瘤患者临床疗效和预后分析  

Analysis of the clinical effects and outcome of patients with double-hit high-risk multiple myeloma

作　　者：刘珊 尚晋[1] 林芸[1] 王志红[1] 魏天南[1] 林玲[1] 杨彤[1] 陈为民[1] Liu Shan;Shang Jin;Lin Yun;Wang Zhihong;Wei Tiannan;Lin Ling;Yang Tong;Chen Weimin(Department of Hematology,Fujian Medical University Shengli Clinical Medical College,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院血液科,福州350001

出　　处：《中华肿瘤杂志》2021年第11期1209-1214,共6页Chinese Journal of Oncology

基　　金：福建省自然科学基金(2018J01259、2019J01504);福建省卫生健康委医学创新课题(2019-CX-2)。

摘　　要：目的分析双打击型高危多发性骨髓瘤(MM)的临床特征、疗效和预后,探讨高危细胞核型对MM的临床意义。方法回顾性分析2011年1月至2019年2月福建省立医院73例高危MM患者的临床资料,采用间期荧光原位杂交法检测染色体核型,根据梅奥mSMART 3.0分期系统的定义,将患者分为双打击组(28例)和非双打击组(45例)。结果15例双打击型与26例非双打击型患者接受硼替佐米为主的化疗,中位无进展生存时间(PFS)分别为8.0和22.0个月,中位总生存时间(OS)分别为10.0个月和未达到。10例双打击型与12例非双打击型患者接受RVD方案(硼替佐米+来那度胺+地塞米松)化疗,中位PFS分别为12.0和24.0个月,中位OS分别为14.0个月和未达到。无论接受硼替佐米为主方案或RVD方案化疗,双打击组患者的OS和PFS均短于非双打击组(均P<0.05)。单因素分析显示,细胞遗传学异常、修订的国际分期系统(R-ISS)分期、β2微球蛋白和钙与高危MM患者的PFS有关(均P<0.05),细胞遗传学异常、R-ISS分期和β2微球蛋白与高危MM患者的OS有关(均P=0.001)。多因素Cox回归分析显示,细胞遗传学异常是高危MM患者OS和PFS的独立影响因素,双打击型患者的疾病进展风险是非双打击型患者的3.160倍(95%CI:1.364~7.318),死亡风险是非双打击型患者的2.966倍(95%CI:1.205~7.306);钙是高危MM患者PFS的独立影响因素,钙≥2.75 mmol/L患者的疾病进展风险是<2.75 mmol/L患者的2.667倍(95%CI:1.209~5.883)。结论双打击型患者是高危MM中预后很差的一个特殊群体,易早期复发和进展,患者生存时间短。Objective To compare the clinical features,clinical efficacy,and prognosis of patients with double-hit and non-double-hit high-risk multiple myeloma(MM)and explored the clinical significance of high-risk cell karyotype in MM development.Methods The clinical data of 73 high-risk MM patients admitted to the Department of Hematology of Fujian Provincial Hospital from January 2011 to February 2019 were retrospectively analyzed.Interphase fluorescence in situ hybridization was used to detect their karyotypes.Based on mSMART 3.0 risk stratification,we divided the patients into a double-hit group(28 cases)and a non-double-hit group(45 cases).Results Fifteen patients in the double-hit group and 26 in the non-double-hit group received bortezomib-based chemotherapy.The median progression-free survival(PFS)in the double-hit and the non-double-hit groups was 8.0 months and 22.0 months,and the median overall survival(OS)was 10.0 months and not reached,respectively.Ten patients in the double-hit group and 12 in the non-double-hit group received bortezomib combined with lenalidomide(RVD)chemotherapy.The median PFS in the double-hit group and the non-double-hit group was 12.0 months and 24.0 months,and the median OS was 14.0 months and not reached,correspondingly.Both the PFS and OS of the double-hit group were significantly shorter than those of the non-double-hit group(P<0.05).Univariate analysis results indicated that cytogenetic abnormalities,revised-international staging system(R-ISS),β2 microglobulin,and calcium had significant effects on PFS in high-risk MM patients(P<0.05).The cytogenetic abnormalities,R-ISS,andβ2 microglobulin were associated with OS in high-risk MM patients(P=0.001).Multivariate Cox regression analysis showed that the cytogenetic grouping was an independent prognostic factor for OS and PFS in high-risk MM patients.The risk of disease progression was 3.160 times(95%CI:1.364-7.318)and the risk of death was 2.966 times higher(95%CI:1.205-7.306)in the double-hit group than those in the non-double-hit gro

关 键 词：多发性骨髓瘤 硼替佐米 预后 双打击 

分 类 号：R733.3[医药卫生—肿瘤]