伴t(11;14)的初治多发性骨髓瘤的临床特征及预后分析  

Clinical characteristics and prognosis of patients with newly-diagnosed multiple myeloma with t(11;14)

作　　者：王焰[1] 刘元昉[1] 陶怡 金诗炜 糜坚青[1] Wang Yan;Liu Yuanfang;Tao Yi;Jin Shiwei;Mi Jianqing(Hematology Department of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai Institute of Hematology,State Key Laboratory of Medical Genomics,National Research Center for Translational Medicine at Shanghai,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院血液科上海血液学研究所医学基因组学国家重点实验室国家转化医学研究中心,上海200025

出　　处：《中华医学杂志》2022年第36期2868-2873,共6页National Medical Journal of China

摘　　要：目的分析伴t(11;14)的初治多发性骨髓瘤(MM)患者的临床特征及预后影响因素。方法回顾性分析2016年1月1日至2021年5月31日在上海瑞金医院确诊的经荧光原位杂交(FISH)检测为伴t(11;14)的45例初治MM患者的临床资料。诱导方案硼替佐米为基础的占88.9%(40/45),免疫调节剂为基础的占11.1%(5/45)。其中31.1%(14/45,移植组)的患者序贯进行大剂量美法仑联合自体造血干细胞移植(AHSCT)。分析了患者临床特征、总有效率(ORR)、无进展生存期(PFS)、总生存期(OS)及预后影响因素。结果患者年龄(58.8±9.6)岁,男62.2%(28/45),骨病变82.2%(37/45)。4疗程诱导治疗后ORR为66.7%(30/45),≥非常好的部分缓解(VGPR)为31.1%(14/45),行AHSCT后≥VGPR率上升到92.9%(13/14)。45例患者随访27(20,42)个月[M(Q1,Q3)],中位PFS为34个月(95%CI:23~45个月),中位OS为44个月(95%CI:33~51个月)。移植组预测中位PFS为48个月(仅3例进展,无CI值),非移植组为24个月(95%CI:13~35个月)(P=0.115)。预测移植组中位OS为60个月(仅1例死亡,无CI值),非移植组48个月(95%CI:22~74个月)(P=0.238)。Cox回归分析显示,骨髓浆细胞数≥50%和浆细胞表达CD20是患者PFS的危险因素[OR=3.272,95%CI:1.167~9.170,P=0.024;OR=3.480,95%CI:1.082~11.234,P=0.036]。未发现影响患者OS的相关因素。结论伴t(11;14)的MM患者一线诱导缓解率不高,AHSCT可加深缓解程度。骨髓浆细胞数过高及浆细胞表达CD20的MM患者可能预后不良。Objective To explore the clinical characteristics and prognosis of multiple myeloma(MM)patients with t(11;14).Methods The clinical data of patients newly diagnosed with MM with t(11;14),which confirmed by fluorescence in situ hybridization(FISH),from January 1,2016 to May 31,2021 in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine was retrospectively collected.A total of 45 patients were included.Bortezomib based induction therapy were given to 88.9%(40/45)patients,while 11.1%(5/45)received Imids-based therapy.Fourteen patients underwent the autologous hematopoietic stem cell transplantation(AHSCT).The clinical characteristics,overall response rate(ORR),progression free survival(PFS),overall survival(OS)and risk factors affecting survival were analyzed.Results The average age of patients were(58.8±9.6)years,and 62.2%(28/45)were male.A relatively high incidence of bone lesion 82.2%(37/45)was observed.After 4 cycles induction therapy,the ORR was 66.7%(30/45),and≥very good partial response(VGPR)was 31.3%(14/45).The rate of≥VGPR increased to 92.9%(13/14)after AHSCT.The follow-up time[M(Q1,Q3)]was 27(20,42)months.The PFS was 34(95%CI:23-45)months,the median OS was 44(95%CI:33-51)months.Median PFS were 48(only 3 cases of progressive disease,CI not available)months and 24(95%CI:13-35)months in the transplantation group and non-transplant group respectively(P=0.115).Median OS were 60(only 1 case of death,CI not available)months and 48(95%CI:22-74)months in the transplantation group and non-transplantation group,respectively(P=0.238).Cox regression analysis indicated that the number of plasma cell≥50%in bone marrow and CD20 expression on myeloma cells were the risk factors for PFS[OR=3.272,95%CI:1.167-9.170,P=0.024;OR=3.480,95%CI:1.082-11.234,P=0.036].No significant effective factor on OS was found.Conclusions For multiple myeloma patient with t(11;14),the response rate with novel agents induction therapy is not high,but autologous stem cell transplantation can deepen remission.The hig

关 键 词：多发性骨髓瘤 自体造血干细胞移植 t(11 14) CD 20 回顾性队列研究 

分 类 号：R733.3[医药卫生—肿瘤]