多发性骨髓瘤并发髓外浸润的临床分析

Clinical features of extramedullary multiple myeloma

目的:了解多发性骨髓瘤(MM)髓外浸润的发生率及临床特点。方法:回顾分析357例MM患者中并发髓外浸润患者的临床表现、实验室检查、疗效及预后。结果:共有43例患者在初诊或治疗过程中出现髓外浸润,发生率为12.04%。Logistic回归分析,发现仅M蛋白类型与是否浸润相关(P<0.05)。最常见的发病部位为软组织(19例次)。共有可评价疗效患者35例。有2例达到接近完全缓解(nCR)(5.7%),7例部分缓解(PR)(20.0%),9例最低限度缓解(MR)(25.7%),总有效率为51.4%,中位疾病进展时间(TTP)为7.5(1～18)个月。其中初治组25例,21例可评价,总有效率为61.9%。复发组18例,17例可评价,总有效率为29.4%。髓外浸润患者的预计总生存期(OS)为31.0个月,无髓外浸润患者的OS为42.4个月(P<0.05)。其中初治组(n=25)的预计OS为19.1个月,复发组(n=18)预计OS为42.7个月(P<0.01)。结论:MM并发髓外浸润可能与M蛋白类型相关,总体疗效欠佳,预后不良,尤其是初诊时即并发髓外浸润者。

Objective：To investigate the incidence and clinical features of extramedullary multiple myeloma（EM）.Method：Three hundred and fifty-seven patients with multiple myeloma（MM） were retrospectively analyzed for the incidence of EM,clinical and laboratory features,therapeutic effects and outcome.Result：Forty-three EM were found at the diagnosis or during therapy,thus the incidence rate was 12.04%.In the logistic regression analysis,only the type of immunoglobulin was associated with EM（P0.05）.The most common location of EM was soft tissues.In 35 patients whose therapeutic effect could be evaluated,2 were nCR（5.7%）,7 were PR（20.0%）,and 9 were MR（25.7%）.Therefore the total effective rate was 51.4%.Median time to progression was 7.5 months（1~18 months）.The estimate overall survival（OS） of patients with EM was significantly shorter than those without EM（31.0 months vs.42.4 months,P0.05）.Twenty-five patients were found to have EM at diagnosis,and their estimate OS was 19.1 months.Eighteen patients were found to have EM during therapy,and their estimate OS was 42.7 months（P0.01）.Conclusion：The incidence of EM may be associated with type of immuglobulin.For patients with EM,conventional chemotherapy is with poor efficacy and the prognosis is unfavourable,especially when the diagnosis of EM is concurrent with the diagnosis of MM.