浆细胞比例和幼浆细胞在初诊多发性骨髓瘤患者预后中的意义  

The Significance of Bone Marrow Plasma Cell Percentage and Im-mature Plasma Cells in the Prognosis of Newly Diagnosed Multiple Myeloma Patients

作　　者：张媛媛 张启科[2] 魏小芳 冯友繁[2] 伏媛[2] 刘菲 陈巧琳 赵阳阳 黄秀娟[2] 陈阳 ZHANG Yuan-Yuan;ZHANG Qi-Ke;WEI Xiao-Fang;FENG You-Fan;FU Yuan;LIU Fei;CHEN Qiao-Lin;ZHAO Yang-Yang;HUANG Xiu-Juan;CHEN Yang(The First School of Clinical Medical,Gansu University OfChinese Medicine;Department of Hematology,Gansu Provincial Hospital,Lanzhou 730000,Gansu Province,China)

机构地区：[1]甘肃中医药大学第一临床医学院 [2]甘肃省人民医院血液科,甘肃兰州730000

出　　处：《中国实验血液学杂志》2025年第2期469-474,共6页Journal of Experimental Hematology

基　　金：甘肃省自然科学基金项目(22JR5RA660);甘肃省人民医院国家级科研项目培育计划一般项目(19SYPYB-13)。

摘　　要：目的:探讨浆细胞比例和幼浆细胞在多发性骨髓瘤(MM)患者预后中的意义。方法:回顾性分析甘肃省人民医院2017年6月至2022年11月126例初诊MM患者的临床资料,依据浆细胞比例中位数(33.5%)将入组患者划分为高浆细胞比例组(A组)和低浆细胞比例组(B组),比较两组患者临床病理资料并绘制生存曲线,分析浆细胞比例对多发性骨髓瘤患者预后的影响;在此基础上依据是否含有幼浆细胞,将A组和B组分别划分为有幼浆细胞组(A1组,B1组)和无幼浆细胞组(A2组,B2组),绘制生存曲线,分析幼浆细胞对多发性骨髓瘤患者预后的影响。结果:在126例MM患者中,A组的国际分期体系(ISS)III期患者比例、β2-微球蛋白(β2-MG)升高的患者比例和有幼浆细胞患者比例明显高于B组(P=0.015,P=0.028,P=0.010)。A组的中位OS为32个月,中位PFS为10个月,B组中位OS未达到,中位PFS为32个月,A组和B组患者3年的OS率分别为46.7%和62.2%(P=0.021),3年PFS分别为29.2%和42.5%(P=0.033)。A1组和A2组之间、B1组和B2组之间OS及PFS差异均无统计学意义(P>0.05)。多因素COX生存分析表明,浆细胞比例≥33.5%(HR=1.253, 95%CI:0.580-2.889,P=0.018)、年龄≥65岁(HR=2.206, 95%CI:1.170-3.510,P=0.012)、乳酸脱氢酶(LDH)≥250 U/L(HR=1.180, 95%CI:0.621-2.398,P=0.048)及β2-MG≥3.5 mg/L(HR=1.507, 95%CI:0.823-3.657,P=0.036)是影响MM患者OS的独立危险因素。结论:初诊浆细胞比例高(≥33.5%)的MM患者较浆细胞比例低(<33.5%)的患者疾病分期晚,PFS及OS差;有无幼浆细胞对患者生存无明显影响。Objective:To explore the significance of the plasma cell percentage and immature plasma cells in the prognosis of patients with multiple myeloma(MM).Methods:The clinical data of 126 newly diagnosed MM patients in Gansu Provincial Hospital from June 2017 to November 2022 were retrospectively analyzed.The enrolled patients were divided into a higher plasma cell percentage group(group A)and a lower plasma cell percentage group(group B)according to the median plasma cell percentage(33.5%).The clinicopathological data of the two groups were compared,and the effect of plasma cell percentage on the prognosis of MM patients was analyzed using survival curves.On this basis,group A and group B were divided into subgroups with immature plasma cells(A1 group,B1 group)and subgroups without immature plasma cells(A2 group,B2 group),respectively,then the survival curves were used to analyze the effect of immature plasma cells on the prognosis of MM patients.Results:Among the 126 patients with MM,the proportions of patients with ISS stage III,elevatedβ2-microglobulin(β2-MG)level,and immature plasma cells in Group A were significantly higher compared those in Group B(P=0.015,P=0.028,P=0.010).The median overall survival(OS)and progression-free survival(PFS)of group A were 32 months and 10 months,respectively.The median OS of group B was not reached,and the median PFS was 32 months.The 3-year OS rates of patients in group A and group B were 46.7%and 62.2%,respectively(P=0.021),and the 3-year PFS were 29.2%and 42.5%,respectively(P=0.033).There were no significant differences in OS and PFS between group A1 and group A2,or between group B1 and group B2(P>0.05).Multivariate COX survival analysis showed that the plasma cell percentage≥33.5%(HR=1.253,95%CI:0.580-2.889,P=0.018),age≥65 years(HR=2.206,95%CI:1.170-3.510,P=0.012),lactate dehydrogenase(LDH)≥250 U/L(HR=1.180,95%CI:0.621-2.398,P=0.048)andβ2-MG≥3.5 mg/L(HR=1.507,95%CI:0.823-3.657,P=0.036)were independent risk factors affecting OS in MM patients.Conclusion:MM patients wi

关 键 词：多发性骨髓瘤 浆细胞比例 幼浆细胞 生存分析 预后 

分 类 号：R733.3[医药卫生—肿瘤]