1q21扩增在多发性骨髓瘤分层治疗中的意义

Significance of 1q21 gains in the risk-adapted treatment of multiple myeloma

目的探讨1q21扩增在多发性骨髓瘤(MM)危险分层治疗中的意义。方法采用荧光原位杂交技术检测60例MM患者的1q21位点,分析1q21扩增与MM临床病理特征的相关性及其对不同危险分层中新药治疗和传统化疗疗效的影响。结果 1q21扩增阳性与MM患者的国际分期系统分期、危险分层以及血红蛋白、白蛋白和β_2微球蛋白水平有关(P<0.05)。采用新药治疗患者的总有效率高于传统化疗患者(90.0% vs.63.3%)(P<0.05)。低危患者采用新药治疗和传统化疗后的总有效率比较差异无统计学意义(P>0.05);高危伴1q21扩增阳性患者采用新药治疗的总有效率高于传统化疗(P<0.05),而高危伴1q21扩增阴性患者采用传统化疗与新药治疗的总有效率比较差异无统计学意义(P>0.05)。结论 MM高危患者采用新药治疗可提高1q21扩增的缓解率,克服1q21扩增对不良预后的影响;而低危患者采用新药治疗相较于传统化疗无明显优势,且1q21扩增与否对治疗效果无影响。

Objective To investigate the significance of 1q21 gains in the risk-adapted treatment of multiple myeloma（MM）.Methods The 1q21 sites of 60 patients with MM were detected by fluorescence in situ hybridization.The correlation between 1q21 gains and clinicopathologic characteristics of MM was analyzed,and the role of 1q21 gains in the therapeutic effect of new drugs and conventional chemotherapy on different risk stratifications of MM was evaluated.Results The 1q21 gains was closely correlated with ISS staging,risk stratification and levels of hemogrobin,albumin and β_2-microglobulin（P〈0.05）.The overall response rate of patients treated with new drugs was higher than that of those treated with conventional chemotherapy（90.0% vs.63.3%）（P〈0.05）.There was no significant difference in overall response rate between new drugs therapy and conventional chemotherapy in the patients with low risk（P〉0.05）.Moreover,the overall response rate of patients with high risk and positive 1q21 gains treated with new drugs was higher than that of those treated with conventional chemotherapy（P〈0.05）,while there was no significant difference in overall response rate between new drugs therapy and conventional chemotherapy in the patients with high risk and negative 1q21 gains（P〉0.05）.Conclusion Using new drugs in the treatment of MM patients with high risk can enhance the response rate of 1q21 amplification and overcome the effect of 1q21 amplification on poor prognosis.However,the response rate in the patients with low risk treated with new drugs is not superior to that treated with conventional chemotherapy and there is no effect on therapeutic efficacy whether 1q21 is amplified or not.