新型免疫治疗时代IgD型多发性骨髓瘤疗效及预后影响因素分析  

Therapeutic effect and prognostic influencing factors of IgD multiple myeloma in the new immunotherapy era

作　　者：刘琼 王莹 朱锋 程海 闫志凌 齐昆明 桑威 李德鹏 李振宇 徐开林 孙海英 Liu Qiong;Wang Ying;Zhu Feng;Cheng Hai;Yan Zhiling;Qi Kunming;Sang Wei;Li Depeng;Li Zhenyu;Xu Kailin;Sun Haiying(Department of Hematology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China)

机构地区：[1]徐州医科大学附属医院血液内科,徐州221002

出　　处：《白血病．淋巴瘤》2022年第7期407-411,共5页Journal of Leukemia & Lymphoma

摘　　要：目的探讨新型免疫治疗时代IgD型多发性骨髓瘤(MM)的临床特征、疗效及预后影响因素。方法回顾性收集2014年3月至2021年2月在徐州医科大学附属医院确诊的29例IgD型MM患者的临床资料,分析其临床特征、治疗方案和疗效,特别是新药和新型免疫治疗的效果。采用Kaplan-Meier法分析总生存(OS)及无进展生存(PFS),采用多因素Cox比例风险模型分析预后影响因素。结果患者中位年龄58岁,<65岁20例(69.0%);合并肾功能损害12例(41.4%),合并髓外侵犯6例(20.7%)。所有患者一线应用含蛋白酶体抑制剂硼替佐米的联合方案治疗,总体有效率为82.8%(24/29)。21例复发难治患者中,二线及以上方案选择嵌合抗原受体T细胞(CAR-T)免疫治疗12例,其中9例获得非常好的部分缓解(VGPR)及以上疗效;选择新药达雷妥尤单抗治疗5例,其中1例获得完全缓解(CR)。29例患者中位OS时间为48个月(95%CI 17~79个月),一线治疗后中位PFS时间为9个月(95%CI 3~15个月),二线治疗后中位PFS时间为11个月(95%CI 1~21个月)。多因素Cox回归分析结果显示,CAR-T治疗是复发难治IgD型MM患者预后的独立保护因素(HR=0.094,95%CI 0.019~0.473,P=0.004)。结论IgD型MM发病年龄较低,合并肾功能损害多见,髓外侵犯发生率较高;一线应用含蛋白酶体抑制剂方案治疗的近期疗效较好,复发难治患者接受CAR-T治疗可一定程度上提高缓解率及生存率。Objective To investigate the clinical characteristics,efficacy and prognostic influencing factors of IgD multiple myeloma(MM)in the new immunotherapy era.Methods The clinical data of 29 patients diagnosed with IgD MM in the Affiliated Hospital of Xuzhou Medical University from March 2014 to February 2021 were retrospectively collected.The clinical characteristics,treatment regimens and efficacy,especially the efficacy of new drugs and immunotherapy for the disease were analyzed.Kaplan-Meier method was used to analyze the overall survival(OS)and progression-free survival(PFS).Multivariate Cox proportional risk model was used for analysis of prognostic influencing factors.Results The median age of patients was 58 years.There were 20 cases(69.0%)below 65 years,12 cases(41.4%)of complicated with stomach function damage,6 cases(20.7%)of extramedullary invasion.All patients were treated with combined therapy containing proteasome inhibitor bortezomib in the first-line therapy,and the overall response rate was 82.8%(24/29).Among 21 relapsed/refractory patients,12 patients were treated with the second-line or above treatment regimen chimeric antigen receptor T cell(CAR-T)immunotherapy,including 9 cases achieving very good partial remission(VGPR)or above;5 patients were treated with the new drug daratozumab,including 1 case achieving complete remission(CR).The median OS time of 29 patients was 48 months(95%CI 17-79 months),the median PFS time after the first-line treatment was 9 months(95%CI 3-15 months),and the median PFS time after the second-line treatment was 11 months(95%CI 1-21 months).Multivariate Cox regression results showed that CAR-T therapy is an independent influencing factor of the prognosis of relapsed/refractory IgD MM patients(HR=0.094,95%CI 0.019-0.473,P=0.004).Conclusions IgD MM patients are characterized with lower onset age,more renal function damage and a high incidence of extramedullary invasion.The first-line therapy containing proteasome inhibitor has a better short-term efficacy,and CAR-T therapy

关 键 词：多发性骨髓瘤 免疫球蛋白D 免疫疗法 嵌合抗原受体T细胞 预后 

分 类 号：R733.3[医药卫生—肿瘤]