早期死亡的多发性骨髓瘤患者临床分析

Clinical analysis of early death in multiple myeloma

目的：探讨新药时代早期死亡的多发性骨髓瘤（multiple myeloma，MM）患者的临床特点。方法：回顾性分析2009年1月至2015年12月北京朝阳医院京西院区收治的188例多发性骨髓瘤患者的临床资料，早期死亡定义为确诊后1年内各种原因所致的死亡。结果：1）早期死亡率10.1%；中位年龄67（40～84）岁；IgG型8例，非IgG型11例；DS分期均为Ⅲ期，伴肾功能不全10例；ISS分期Ⅱ期4例，Ⅲ期15例；伴髓外浸润（EMP）6例；10例遗传学高危；5例乳酸脱氢酶升高；3例淀粉样变性；2例浆细胞白血病；体能状态评分（KPS）20～80分，中位评分70分；16例使用含硼替佐米的方案化疗，3例使用CADT方案化疗。2）可评价疗效的13例，总反应率（orerall response rate，ORR）46.2%（6/13），接近完全缓解率（CR＋nCR）7.7%（1/13）；3）中位生存3（1～11.5）个月，继发浆细胞白血病的2例生存期不到2个月；4）19例患者中死于疾病进展8例（42.1%），死于严重感染8例（42.1%），死于血栓事件3例。结论：遗传学高危、LDH高、伴EMP、继发淀粉样变性、高龄、体能状态差以及治疗期间严重并发症是导致MM患者早期死亡的重要原因。新药时代需探索高危MM的个体化治疗，降低MM的早期死亡率，使更多的MM患者获益。

Objective：This study investigated the clinical characteristics of multiple myeloma with early death in the era of novel drugs. Methods：Medical records from 188 patients diagnosed from January 2009 to December 2015 were retrospectively reviewed, showing that early death occurred in 19 patients. Early death was defined as death by any cause within the first year after diagnosis. Results：（1） Early mortality was 10.1%, and the median age was 67 years old （range：40-84 years）. Eight cases presented IgG type, and 11 cases were non-IgG type. All 19 patients were diagnosed to be at stageⅢin accordance with the Durie–Salmon staging system, and renal insufficiency occurred in 10 patients. In accordance with the International Staging System （ISS）, four patients were diagnosed to be at stageⅡ, whereas 15 other patients were at stageⅢ. Extramedullary plasmacytoma （EMP） occurred in six cases, whereas 10 cases pre-sented high-risk patients with cytogenetic abnormalities. Elevated lactate dehydrogenase （LDH） was found in five cases, amyloidosis was detected in three patients, and secondary plasma cell leukemia was observed in two cases. The median score of performance sta-tus （KPS） was 70 （range： 20-80）. A total of 16 patients were treated with bortezomib, and 3 patients were treated with CADT. （2） Among the 13 patients who were evaluated, the overall response rate was 46.2%（6/13）, and the complete response （CR） and near-CR rate was 7.7%（1/13）. （3） The median overall survival was 3 （1-11.5） months, although the two patients with secondary plasma cell leu-kemia survived for less than 2 months. （4） Eight patients died of disease progression （42.1%）, eight patients died of severe infections （42.1%）, and three patients died of thrombotic events. Conclusion：The important causes of early death include the following：high-risk cytogenetics, elevated LDH, EMP, amyloidosis, advanced age, poor performance status, and serious complications during treat-ment. In the era of novel drugs, we should improve early diagnosis rates and explore individualized treatment for high-risk multiple my-eloma for the benefit of a wide range of patients.