sFLC/MP水平及轻链逃逸在多发性骨髓瘤复发患者中的临床意义  

Clinical Significance of sFLC/MP Level and Light Chain Escape in Patients with Multiple Myeloma Relapse

作　　者：香雪 柴晔[1] 王鑫[1] 马成成 王茵 李艳青 XIANG Xue;CHAI Ye;WANG Xin;MA Cheng-Cheng;WANG Yin;LI Yan-Qing(Department of Hematology,Lanzhou University Second Hospital,Lanzhou 730000,Gansu Province,China)

机构地区：[1]兰州大学第二医院血液科,甘肃兰州730000

出　　处：《中国实验血液学杂志》2021年第6期1837-1844,共8页Journal of Experimental Hematology

摘　　要：目的:探讨不同水平血清游离轻链(sFLC)和单克隆免疫球蛋白(MP)对多发性骨髓瘤(MM)复发患者疗效及预后的影响,以及轻链逃逸(LCE)的临床意义。方法:回顾性分析71例MM患者复发后sFLC/MP水平与临床特征及转归的关系,根据复发后sFLC/MP水平将患者分为MO组、MLC组及LCE组,比较各组患者的临床指标、疗效、复发后生存期(SAR)及总生存期(OS),并采用配对样本t检验对LCE组内复发前后相关指标进行分析。结果:各组患者在ISS分期、复发后sFLC/MP水平、Hb、PLT、ALB及骨髓浆细胞比例方面有统计学差异(P<0.05);MO组患者初治疗效优于其他两组,LCE组初治疗效最差(P<0.05);LCE组内复发前后相关指标比较,MP、Hb和PLT水平显著下降,sFLC、LDH和Cr水平显著升高(P<0.05);多因素分析显示,MO是影响患者SAR的独立危险因素,MO和LCE是影响患者OS的独立危险因素(P<0.05);MO组、MLC组及LCE组平均SAR分别为41个月、28.6个月、23.5个月(P=0.002),平均OS分别为79.6个月、57.9个月、41个月(P<0.001),MO组患者具有更长的SAR和OS,而LCE组患者的SAR和OS最短。结论:复发后仅MP升高的患者疗效及预后较好,仅sFLC升高的患者疗效及预后差,sFLC/MP水平可作为预测MM患者预后的良好指标。其中LCE提示患者疾病进展、预后不良及早期复发。Objective: To explore the effects of serum free light chain(sFLC) and monoclonal protein(MP) on the efficacy and prognosis of patients with multiple myeloma relapse, and investigate the clinical value of light chain escape(LCE). Methods: The relationship between sFLC/MP levels and clinical features and outcomes in 71 patients with multiple myeloma after relapse were retrospective analyzed. The patients were divided into MO group, MLC group and LCE group according to different levels of sFLC/MP after relapse. Then the clinical indicators, efficacy, survival after relapse(SAR) and overall survival(OS) of the patients in each group were compared. Meanwhile a paired sample t test was used to analyze the relevant indicators of the patients before and after relapse in LCE group. Results: There were significant differences in ISS stage, the levels of Hb, PLT, ALB, SFLC/MP and the proportion of myeloplasma cells afte relapse(P<0.05). The initial treatment effect of the patients in MO group was better than those in the other groups, and the LCE group was the worst(P<0.05). Comparison of relevant indicators between the patients before and after relapse in LCE group showed that the levels of MP, Hb and PLT decreased significantly, while sFLC, LDH and Cr increased significantly(P<0.05). Multivariate analysis showed that MO was the independent risk factor affecting SAR, while MO and LCE were the independent risk factors affecting OS(P<0.05) of the patients.The average SAR of the patients in MO, MLC and LCE group was 41, 28.6 and 23.5 months(P=0.002), and the average OS was 79.6, 57.9 and 41 months(P<0.001), respectively. The patients in MO group showed longer SAR and OS, while the LCE group was the shortest.Conclusion: After relapse, patients only with elevated MP levels have a better curative effect and prognosis, while only with elevated sFLC levels have poor curative effects and prognosis, which suggesting that sFLC/MP levels can be used as a good indicator for predicting the prognosis of multiple myeloma patients.The appe

关 键 词：多发性骨髓瘤 复发 轻链逃逸 血清游离轻链 单克隆免疫球蛋白 预后 

分 类 号：R733.3[医药卫生—肿瘤]