三类/四类暴露复发难治性多发性骨髓瘤患者的临床特征及生存分析  

Clinical characteristics and survival analysis of patients with triple/quad-class exposed relapsed or refractory multiple myeloma

作　　者：安静 赵洁[2] 马艳萍 秦小琪 马爻芳 李志华 郎筠渊 高国荣[7] 刘文华 段文义 魏俊妮[1] 田卫伟 Jing An;Jie Zhao;Yanping Ma;Xiaoqi Qin;Yaofang Ma;Zhihua Li;Junyuan Lang;Guorong Gao;Wenhua Liu;Wenyi Duan;Junni Wei;Weiwei Tian(School of Public Health,Shanxi Medical University,Taiyuan 030001,China;Department of Hematology,Third Hospital of Shanxi Medical University,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital,Taiyuan 030032,China;Department of Hematology,Second Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Hematology,Yuncheng Central Hospital,Yuncheng 044099,China;Department of Hematology,Sinopharm General Hospital,Datong 037003,China;Department of Hematology,Jincheng People's Hospital,Jincheng 048026,China;Department of Hematology,Linfen People's Hospital,Linfen 041081,China;Department of Hematology,Shanxi Provincial People's Hospital,Taiyuan 030012,China;Department of Hematology,Yuncheng People's Hospital,Yuncheng 044099,China)

机构地区：[1]山西医科大学公共卫生学院,太原市030001 [2]山西医科大学第三医院,山西白求恩医院(山西医学科学院),同济山西医院 [3]山西医科大学第二医院 [4]运城市中心医院 [5]国药同煤总医院 [6]晋城市人民医院 [7]临汾市人民医院 [8]山西省人民医院 [9]运城市人民医院

出　　处：《中国肿瘤临床》2024年第23期1218-1222,共5页Chinese Journal of Clinical Oncology

基　　金：山西省基础研究计划项目(编号:202303021211224)资助。

摘　　要：目的:探讨三类/四类暴露复发难治性多发性骨髓瘤(relapsed or refractory multiple myeloma,RRMM)患者的临床特征与生存预后。方法:回顾性分析2017年5月至2024年5月山西省8所医院(山西白求恩医院、山西医科大学第二医院、运城市中心医院、国药同煤总医院、晋城市人民医院、临汾市人民医院、山西省人民医院和运城市人民医院)三类/四类暴露RRMM患者的临床数据,用Kaplan-Meier法分析总生存期(overall survival,OS)和无进展生存期(progression-free survival,PFS),Cox模型及Log-rank检验分析影响因素。结果:112例三类暴露患者中16例为四类暴露。三类暴露患者高风险细胞遗传学异常及髓外病变的检出率分别为57.1%和36.6%,四类暴露患者分别为87.5%和62.5%;三类暴露患者的中位PFS和OS分别为5.6个月和12.2个月,四类暴露患者分别为9.4个月和16.9个月。Cox模型分析显示,髓外病变、多线治疗(≥3线)是影响三类暴露RRMM患者生存的独立危险因素(P<0.05);既往自体干细胞移植、后续常规药物治疗及B细胞成熟抗原(B-cell maturation antigen,BCMA)的嵌合抗原受体T细胞(chimeric antigen receptor T,CAR-T)治疗为保护因素(P<0.05)。三类耐药后,Logrank检验证实BCMA CAR-T治疗较常规药物治疗显著延长患者中位PFS(9.4个月vs.5.2个月)(P=0.0269),但OS差异无统计学意义(16.9个月vs.7.9个月)(P=0.2634)。结论:三类/四类暴露RRMM患者预后差,BCMA CAR-T细胞治疗可改善三类耐药RRMM患者生存期。Objective:To investigate the clinical characteristics and survival prognosis of patients with triple/quad-class exposed relapsed or refractory multiple myeloma(RRMM).Methods:The clinical data of patients with triple/quad-class exposed RRMM from eight centers in Shanxi Province between May 2017 and May 2024 were retrospectively analyzed.Overall survival(OS)and progression-free survival(PFS)were analyzed using the Kaplan-Meier method,and factors affecting survival were examined by the Cox proportional hazards model and Logrank test.Results:Among the 112 patients with triple-class exposure,16 were quadruple-class exposed.The detection rates of high-risk cytogenetic abnormalities and extramedullary lesions in patients with triple-class exposure were 57.1%and 36.6%,respectively,while those in patients with quadruple-class exposure were 87.5%and 62.5%,respectively.The median PFS and OS of patients with triple-class exposure were 5.6 months and 12.2 months,respectively,while those of patients with quadruple-class exposure were 9.4 months and 16.9 months,respectively.Cox model analysis showed that extramedullary lesions and multi-line treatment(≥3 lines)were independent risk factors for the survival of patients with triple-class exposed RRMM(P<0.05).Previous autologous stem cell transplantation,subsequent con-ventional drug treatment,and B-cell maturation antigen(BCMA)chimeric antigen receptor T-cell(CAR-T)treatment were protective factors(P<0.05).After triple-class drug resistance,the Log-rank test verified that BCMA CAR-T treatment significantly prolonged the median PFS of patients compared to conventional drug treatment(9.4 months vs.5.2 months,P=0.0269),whereas the difference in OS was not statistically significant(16.9 months vs.7.9 months,P=0.2634).Conclusions:Patients with triple/quad-class exposed RRMM have a poor prognosis,and BCMA CAR-T cell therapy can improve survival in patients with triple-class drug-resistant RRMM.

关 键 词：复发/难治性多发性骨髓瘤 三类/四类暴露 嵌合抗原受体 T 细胞疗法 (CAR-T) 生存分析 B细胞成熟抗原 靶向治疗 

分 类 号：R73[医药卫生—肿瘤]