新药时代原发性浆细胞白血病预后因素分析  

Analysis of the prognostic factors in primary plasma cell leukemia in the era of novel agents

作　　者：邓晶晶 金小云 张之尧 周慧星[1] 杨光忠[1] 耿传营[1] 菅原[1] 陈文明[1] 高文[1] Deng Jingjing;Jin Xiaoyun;Zhang Zhiyao;Zhou Huixing;Yang Guangzhong;Geng Chuanying;Jian Yuan;Chen Wenming;Gao Wen(Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院,北京100020

出　　处：《中华血液学杂志》2024年第7期645-650,共6页Chinese Journal of Hematology

基　　金：北京市自然科学基金(7212041)。

摘　　要：目的探讨新药时代原发性浆细胞白血病(pPCL)的预后因素。方法回顾性收集2011年至2022年就诊于首都医科大学附属北京朝阳医院血液科66例pPCL患者的临床资料,分析其预后因素。结果66例pPCL患者中位发病年龄为59(29~79)岁。中位总生存(OS)期为19.0(95%CI 10.4~27.6)个月,中位无进展生存(PFS)期为11.0(95%CI 6.5~15.6)个月。治疗后最佳疗效≥非常好的部分缓解(VGPR)患者的中位OS期和PFS期均显著长于疗效≤部分缓解(PR)患者(中位OS期:33.0个月对6.0个月,P<0.001;中位PFS期:16.0个月对3.0个月,P<0.001)。接受自体造血干细胞移植患者的OS期较未接受患者显著延长(49.0个月对6.0个月,P=0.002),PFS期也有延长趋势(19.0个月对8.0个月,P=0.299)。接受维持治疗患者的中位OS期、PFS期较未接受维持治疗患者显著延长(中位OS期:56.0个月对4.0个月,P<0.001;中位PFS期:20.0个月对2.0个月,P<0.001)。多因素分析结果表明,高钙血症是影响pPCL患者OS的独立危险因素(HR=3.204,95%CI 1.068~9.610,P=0.038);接受维持治疗(HR=0.075,95%CI 0.022~0.253,P<0.001)、治疗后疗效≥VGPR(HR=0.175,95%CI 0.048~0.638,P=0.008)是影响pPCL患者OS的独立保护因素。结论在新药时代,高钙血症、接受维持治疗、治疗后疗效≥VGPR是pPCL的独立预后因素。Objective:To explore the prognostic factors of primary plasma cell leukemia(pPCL)in the era of novel agents.Methods:The clinical data of 66 patients with pPCL treated at the Department of Haematology,Beijing Chao-Yang Hospital,Capital Medical University from 2011 to 2022 were retrospectively collected to analyze their prognostic factors.Results:Among the 66 patients with pPCL,the median age was 59(range:29-79)years.The median overall survival(OS)duration was 19.0(95%CI 10.4-27.6)months,and the median progression-free survival(PFS)duration was 11.0(95%CI 6.5-15.6)months.The median OS and PFS were significantly longer in patients with the best post-treatment response of very good partial remission(VGPR)or better than in patients with a response of partial remission(PR)or worse(median OS:33.0 months vs 6.0 months,P<0.001;median PFS:16.0 months vs 3.0 months,P<0.001).OS was significantly longer in patients who underwent autologous hematopoietic stem cell transplantation than in those who did not undergo transplantation(49.0 months vs 6.0 months,P=0.002),and there was a trend toward a longer PFS in patients who underwent transplantation than in those who did not undergo transplantation(19.0 months vs 8.0 months,P=0.299).The median OS and PFS were significantly longer in patients who received maintenance therapy than in those who did not receive maintenance therapy(median OS:56.0 months vs 4.0 months,P<0.001;median PFS:20.0 months vs 2.0 months,P<0.001).Multivariate analysis showed that hypercalcemia was an independent risk factor(HR=3.204,95%CI 1.068-9.610,P=0.038)for patients with pPCL,while receiving maintenance therapy(HR=0.075,95%CI 0.022-0.253,P<0.001)and post-treatment response of VGPR or better(HR=0.175,95%CI 0.048-0.638,P=0.008)were independent protective factors for patients with pPCL.Conclusions:In the era of novel agents,hypercalcemia,receiving maintenance therapy,and post-treatment response of VGPR or better are independent prognostic factors for pPCL.

关 键 词：白血病 浆细胞 预后 高钙血症 维持治疗 治疗结果 

分 类 号：R733.7[医药卫生—肿瘤]