湖南省多发性骨髓瘤诊治现状  

Diagnosis and treatment of multiple myeloma in Hunan Province

作　　者：刘菲阳 成倩[1] 宋奎 禹环[3] 李君君[4] 张辉 胡国瑜 周明[7] 王俊[8] 丁忠奇[9] 罗自勉 彭婷 丁亮[1] 赵俩 刘竞[1] 贺艳娟[11] 彭宏凌[12] LIU Feiyang;CHENG Qian;SONG Kui;YU Huan;LI Junjun;ZHANG Hui;HU Guoyu;ZHOU Ming;WANG Jun;DING Zhongqi;LUO Zimian;PENG Ting;DING Liang;ZHAO Liang;LIU Jing;HE Yanjuan;PENG Hongling(Department of Hematology,Third Xiangya Hospital,Central South University,Changsha 410013;Department of Hematology,Xiangxi Autonomous Prefecture People’s Hospital,Jishou Hunan 416007;Department of Hematology,First People’s Hospital of Chenzhou,Chenzhou Hunan 423000;Department of Hematology,First Affiliated Hospital of University of South China,Hengyang Hunan 421001;Department of Hematology-Oncology,Central Hospital of Shaoyang,Shaoyang Hunan 422099;Department of Hematology,Central Hospital of Zhuzhou,Zhuzhou Hunan 412007;Department of Hematology,First Affiliated Hospital of Hunan Normal University,Changsha 410005;Department of Hematology,First People’s Hospital of Changde City,Changde Hunan 415003;Department of Hematology,First People’s Hospital of Huaihua,Huaihua Hunan 418099;Department of Hematology,Central Hospital of Xiangtan,Xiangtan Hunan 411199;Department of Hematology,Xiangya Hospital,Central South University,Changsha 410008;Department of Hematology,Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅三医院血液科,长沙410013 [2]湘西自治州人民医院血液科,湖南吉首416007 [3]郴州市第一人民医院血液科,湖南郴州423000 [4]南华大学附属第一医院血液科,湖南衡阳421001 [5]邵阳市中心医院血液肿瘤科,湖南邵阳422099 [6]株洲市中心医院血液科,湖南株洲412007 [7]湖南师范大学附属第一医院血液科,长沙410005 [8]常德市第一人民医院血液科,湖南常德415003 [9]怀化市第一人民医院血液科,湖南怀化418099 [10]湘潭市中心医院血液科,湖南湘潭411199 [11]中南大学湘雅医院血液科,长沙410008 [12]中南大学湘雅二医院血液科,长沙410011

出　　处：《中南大学学报（医学版）》2022年第4期497-504,共8页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(81870166);湖南省自然科学基金(2021JJ40916)。

摘　　要：目的:国内多发性骨髓瘤(multiple myeloma,MM)临床大数据较少,本研究旨在分析湖南省多中心1年期间新诊断多发性骨髓瘤(newly diagnosed multiple myeloma,NDMM)患者的临床资料,了解湖南省MM患者真实的临床特征和诊疗情况,加强对MM规范化诊疗流程和诊疗方案的认识。方法:收集湖南省12家大型综合性医院2019年1月1日至12月31日收治的共529例NDMM患者的临床资料,包括基线资料、治疗方案、疗程和不良反应等。采用SPSS 21.0统计软件分析患者的临床特征、治疗情况及安全性。结果:529例NDMM患者确诊年龄33~90(中位数64)岁,男女比为1.38?1;临床特征占比从高到低依次为骨痛(77.7%)、贫血(66.8%)、肾功能不全(40.6%)、高钙血症(15.1%)。分型:IgG型46.5%,IgA型24.6%,IgD型2.6%,IgM型0.8%,轻链型15.7%,双克隆型3.0%,不分泌0.6%,缺失6.2%。DS(Durie-Salmon)分期Ⅰ期、Ⅱ期、Ⅲ期分别为4.5%、10.6%、77.3%,缺失40例(7.6%);国际分期系统(International Staging System,ISS)分期Ⅰ期、Ⅱ、Ⅲ期分别为10.4%、24.4%、47.6%,缺失93例(17.6%);修订的国际分期系统(Revised International Staging System,R-ISS)分期Ⅰ期、Ⅱ、Ⅲ期分别为5.5%、27.0%、23.1%,缺失235例(44.4%),其中中南大学湘雅三医院单中心98例NDMM患者中DS分期缺失2.0%,ISS分期缺失12.3%,R-ISS分期缺失12.3%。治疗情况:529例患者中475例接受治疗,接受治疗率为89.8%;67.4%的患者能规范完成4个疗程诱导阶段的化学治疗(以下简称化疗),其中90.3%的患者接受1次以上以蛋白酶体抑制剂为基础的化疗方案,67.2%接受1次以上以免疫调节剂为基础的化疗方案,59.8%的患者接受1次以上含蛋白酶体抑制剂与免疫调节剂的联合化疗方案。疗效:4个疗程组总缓解率(overall response rate,ORR)及高质量缓解率(high quality response rate,HQR)均优于2个疗程组(ORR为85%vs 65%,P=0.006;HQR为68.3%vs 24.0%,P<0.001),规范化治疗组HQR优于非规范化治疗组(65.1%vs 4Objective:There is less clinical data on multiple myeloma(MM)in China,and the aim of this study was to collect and analyze the clinical data of newly diagnosed multiple myeloma(NDMM)patients in Hunan Province during 1 year,to understand the real clinical features and treatment outcome for Hunan Province patients with MM,and to strengthen the understanding of the standardized diagnosis process and treatment plan of MM.Methods:The clinical data of 529 patients with NDMM in 12 large-scale general hospitals in Hunan Province from January 1 to December 31,2019 were collected and analyzed,including baseline data,treatment regimens,duration of treatment,and adverse reactions.The clinical characteristics,treatment,and safety of patients were analyzed by SPSS 21.0.Results:Among the 529 NDMM patients,the age was 33-90(median 64)years and the male-female ratio was 1.38?1.The clinical features ranged from high to low were as follows:Bone pain(77.7%),anemia(66.8%),renal insufficiency(40.6%),hypercalcemia(15.1%).Typing:IgG 46.5%,IgA 24.6%,IgD 2.6%,IgM 0.8%,light chain 15.7%,double clone 3.0%,no secretion 0.6%,absence 6.2%.Staging:Durie-Salmon stageⅠ,Ⅱ,andⅢwere 4.5%,10.6%,77.3%,respectively,and 40 cases(7.6%)missed this data.International Staging System(ISS)stageⅠ,Ⅱ,andⅢwere 10.4%,24.4%,and 47.6%,respectively,and93 cases(17.6%)were missing.Revised International Staging System(R-ISS)stageⅠ,Ⅱ,andⅢwere 5.5%,27.0%,23.1%,respectively,and 235 cases(44.4%)missed this data.Among the 98 NDMM patients in the Third Xiangya Hospital,Central South University,Durie-Salmon(DS)stage missing 2.0%,ISS stage missing 12.3%,and R-ISS stage missing12.3%.Treatment:Among the 529 patients,475 received treatment,the rate of treatment was89.8%;67.4%of the patients were able to complete four courses of chemotherapy at induction phase,90.3%of the patients received proteasome inhibitor based combination chemotherapy regimen more than once,67.2%received immunomodulator based regimen more than once,and 59.8%of the patients received proteasom

关 键 词：多发性骨髓瘤 多中心研究 真实世界研究 

分 类 号：R733.3[医药卫生—肿瘤]