高危多发性骨髓瘤的临床特征及VRD方案介入治疗的效果  

Clinical characteristics of high-risk multiple myeloma and the effiectiveness of VRD interventional therapy

作　　者：庞爱萍 罗泉芳[1] 陈钦玭 王薇[1] 缪志超 曾妮妮 张健坤[1] 吴春林[1] PANG Aiping;LUO Quanfang;CHEN Qinpin;WANG Wei;MIAO Zhichao;ZENG Nini;ZHANG Jiankun;WU Chunlin(Nanxishan Hospital of Guangxi Zhuang Autonomous Region,Guilin 541000,China)

机构地区：[1]广西壮族自治区南溪山医院,桂林541000

出　　处：《华夏医学》2024年第5期149-154,共6页Acta Medicinae Sinica

基　　金：广西壮族自治区卫生健康委员会自筹经费项目(Z20200931)。

摘　　要：目的分析VRD方案(硼替佐米+来那度胺+地塞米松)对伴有高危细胞遗传学(HRCA)多发性骨髓瘤(MM)的治疗效果及高危MM的临床特征。方法选取77例初诊多发性骨髓瘤(NDMM)患者,分为高危组50例及非高危组27例,比较两组的临床特点。高危组进一步分为VRD组及非VRD组,比较两组的治疗效果。结果高危组的血尿酸水平高于非高危组,差异有统计学意义(P<0.05);两组血红蛋白、肾功能、血钙、白蛋白、球蛋白、乳酸脱氢酶、β2微球蛋白、骨质破坏情况、ISS分期比较,差异均无统计学意义(P>0.05);VRD组的深度缓解率优于非VRD组(P<0.05);两组总体有效率、完全缓解率、非常好的部分缓解率、部分缓解率比较,差异均无统计学意义(P>0.05);VRD组的中位无进展生存期(PFS)长于非VRD组(P<0.05),而两组中位总生存期(OS)均未达到,且两组总体生存期比较,差异无统计学意义(P>0.05)。结论血尿酸是NDMM患者不良预后因素之一,高尿酸的NDMM患者可能伴有HRCA表达。VRD诱导治疗可明显提高伴有HRCA的MM深度缓解率,且能延长PFS。Objective To analyze the efficacy of the VRD regimen(bortezomib+lenalidomide+dexamethasone)on multiple myeloma(MM)with high-risk cytogenetic abnormality(HRCA)and to analyze the clinical characteristics of high-risk MM.Methods 77 patients with newly diagnosed multiple myeloma(NDMM)were selected and were divided into a high-risk group of 50 cases and a non high-risk group of 27 cases.The clinical characteristics of the two groups were compared.The high-risk group was further divided into VRD induction group and non-VRD induction group,and the treatment effects of the two groups were compared.Results The level of blood uric acid in the high-risk group was higher than that in the non high-risk group,and the difference was statistically significant(P<0.05).There was no statistically significant difference between the two groups in terms of hemoglobin,renal function,blood calcium,albumin,globulin,lactate dehydrogenase,β2-microglobulin,bone destruction,and ISS staging(P>0.05).The deep remission rate in the VRD induced group was better than that in the non VRD induced group(P<0.05).There was no statistically significant difference in the overall effective rate,complete response rate,very good partial response rate,and partial response rate between the two groups(P>0.05).The median progression free survival(PFS)in the VRD induced group was longer than that in the non VRD induced group(P<0.05),while the median overall survival(OS)of both groups was not reached,and there was no statistically significant difference in overall survival(P>0.05).Conclusion Blood uric acid is one of the poor prognostic factors in NDMM patients,and NDMM patients with high uric acid may be accompanied by HRCA expression.VRD induction therapy can significantly increase the deep remission rate of multiple myeloma with HRCA and can prolong its PFS.

关 键 词：高危细胞遗传学 多发性骨髓瘤 硼替佐米 来那度胺 地塞米松 

分 类 号：R733.3[医药卫生—肿瘤]