新诊断多发性骨髓瘤168例临床特征分析与预后模型构建  

Analysis of clinical characteristics in 168 patients with newly diagnosed multiple myeloma and prognostic model construction

作　　者：陈金香 王正阳 吴振添 李冰莹 郑志宏[4] 陈鑫基 郑静[4] CHEN Jinxiang;WAN-Zhengyang;WU Zhentian;LI Bingying;ZHEN-Zhihong;CHEN Xinji;ZHEN-Jing(Department of Hematology,Mindong Hospital of Ningde City,Fujian Province,Fu'an,Fujian 355000,China;Fujian Medical University,Fuzhou,Fujian 350122,China;Second Departmentof Cadre Ward,the 900th Hospitalofthe Joint Logistics Support Forceofthe People's Liberation Army,Fuzhou,Fujian 350025,China;Departmentof Hematology,Fujian Medical University Union Hospital,Fuzhou,Fujian 350001,China;Departmentof Hematology,the Second Hospital of Fuzhou City,Fujian Province,Fuzhou,Fujian 350007,China)

机构地区：[1]福建省宁德市闽东医院血液内科,福安355000 [2]福建医科大学,福州350122 [3]中国人民解放军联勤保障部队第九〇〇医院干部病房二科,福州350025 [4]福建医科大学附属协和医院血液科,福州350001 [5]福建省福州市第二总医院血液科,福州350007

出　　处：《福建医药杂志》2025年第2期16-20,共5页Fujian Medical Journal

摘　　要：目的探索新诊断多发性骨髓瘤(MM)患者的临床特征与预后因素,并构建MM患者疾病预后预测模型。方法回顾性分析2016年1月1日至2020年1月1日期间福建医科大学附属协和医院收治的168例初诊MM患者的临床特征与预后因素,并构建疾病预后预测模型。结果168例MM患者中位发病年龄56岁,临床分型以IgG型为主(占56.54%),mSMART分期以高危为主(占66.67%)。4个疗程治疗后总有效率(ORR)为88.69%,其中严格意义的完全缓解(sCR)及完全缓解(CR)占31.55%。中位无进展生存期(PFS)与总生存期(OS)分别为34个月与56个月。多因素分析发现1q21扩增、未含硼替佐米的诱导化疗、4个疗程后疗效未达CR是影响MM患者PFS的独立危险因素;1q21扩增、del(17p13)、4个疗程后疗效未达CR、未接受自体造血干细胞移植(ASCT)是影响患者OS的独立危险因素,基于这些独立危险因素构建的预测模型具有一定的预后预测价值。结论临床上MM以IgG型最为常见,就诊时以mSMART高危为主。1q21扩增、del(17p13)、未含硼替佐米的诱导化疗、4个疗程后疗效未达CR及未接受ASCT是影响MM患者远期预后的独立危险因素,基于这些危险因素构建的疾病预测模型有助于风险评估及预后预测。Objective To investigate the clinical characteristics and prognostic factors in newly diagnosed multiple myeloma(MM)patients and to construct a prognostic prediction model for MM.Methods A retrospective analysis was performed on 168 newly diagnosed MM patients treated in Fujian Medical University Union Hospital between January 1st,2016,and January 1st,2020.Clinical features and prognostic factors were evaluated,and a prognostic prediction model was established.Results The median age of the 168 MM patients was 56 years,with IgG type being the predominant subtype(56.54%).Based on the mSMART staging system,66.67%of patients were categorized as high-risk.The overall response rate(ORR)after four courses of treatment was 88.69%,with stringent complete response(sCR)and complete response(CR)observed in 31.55%of cases.The median progression-free survival(PFS)and overall survival(OS)were 34 months and 56 months,respectively.Multivariate analysis revealed that 1q21 amplification,induction chemotherapy without bortezomib,and failure to achieve CR after four courses of treatment were independent risk factors for PFS.Furthermore,1q21 amplification,del(17p13),failure to achieve CR after four courses of treatment,and not undergoing autologous stem cell transplantation(ASCT)were identified as independent risk factors for OS.The prediction model incorporating these factors demonstrated significant prognostic utility.Conclusion IgG-type MM is the most prevalent clinical subtype,with the majority of patients presenting as high-risk according to mSMART staging.Key independent risk factors influencing long-term prognosis include 1q21 amplification,del(17p13),induction chemotherapy without bortezomib,failure to achieve CR after four courses of treatment,and not receiving ASCT.The prognostic model constructed based on these factors provides valuable insights for risk assessment and outcome prediction in MM patients.

关 键 词：多发性骨髓瘤 临床特征 预后 预测模型 

分 类 号：R733.3[医药卫生—肿瘤]