免疫球蛋白重/轻链检测在IgA型多发性骨髓瘤患者预后判断中的作用

The role of immunoglobulin heavy/light chain detection in the prognosis of IgA multiple myeloma

目的:观察疗效评估为非常好的部分缓解(VGPR)及以上的IgA型多发性骨髓瘤(MM)患者中血清免疫球蛋白重/轻链(HLC)和游离轻链(FLC)及免疫固定电泳(IFE)的结果,探讨HLC在IgA型MM患者疗效和预后评估中的作用。方法:收集54例治疗后疗效评估为VGPR及以上IgA型MM患者血清样本,采用散射免疫比浊法在全自动SPA plus特定蛋白分析仪上进行HLC及FLC检测。结合同期IFE检测结果,评价HLC在IgA型MM疗效及预后判断中的价值。结果:(1)54例IgA型MM患者中,22例rHLC(HLC IgA-κ/IgA-λ比值)异常,其中IgA-κ型13例,IgA-λ型9例,rHLC检测结果的中位数分别为4.30、0.29;rHLC异常组与rHLC正常组中位无进展生存期(PFS)分别为7.8个月与13.0个月(P=0.018);中位总生存期(OS)分别为11.2个月和13.2个月(P=0.048)。(2)54例患者中,15例IFE、rHLC、rFLC 3项指标均正常为A组;12例有1项指标异常为B组;18例有2项指标异常为C组;9例3项指标均异常为D组;A、B、C、D组中位PFS分别为16.6个月、14.2个月、7.8个月、7.0个月(P=0.019);中位OS分别为18.7个月、16.5个月、9.4个月、9.3个月(P=0.016)。结论:达到VGPR及以上疗效的MM患者仍能检出rHLC的异常,rHLC异常提示患者预后不良;HLC与FLC及IFE检测的联合应用可以更好地对IgA型MM患者进行预后监测。

Objective：To investigate the role of immunoglobulin heavy/light chain （HLC） in the clinical effica- cy and prognosis of IgA multiple myeloma （MM） patients who have achieved VGPR or better response through observation the expression of immunoglobulin HLC and free light chain （FLC） and immunofixation electrophoresis （IFE）. Method： The HLC and FLC were measured by immune scatter turbidimetry with automatic SPA plus analy sis machine in 54 patients of IgA MM who had achieved VGPR or better response. Concurrent IFE results were al- so incorporated and analyzed to estimate the role of HI.C in the clinical efficacy and prognosis of IgA MM patients. Result： ①There were 22 patients with abnormal rHLC （HLC IgA-g/IgA-λ ratios） among 54 patients,ineluding 13 cases of IgA-κ,9 cases of IgA-λ. The median abnormal rHLC detection result of IgA-κ and IgA-λ were 4.30,0.29, respectively. The median progression free survival （PFS） of abnormal rHLC group and normal rHLC group were 7.8 months and 13.0 months （P=0. 018）, and the median overall survival （OS） were 11.2 months and 13.2 months,respectively （P=0. 048）. ②The median PFS were 16.6,14.2,7.8,7.0 months （P=0. 019） and median OS were 18.7,16.5,9.4,9.3 months （P = 0. 016） respectively for the patients with all normal rHLC, rFLC and IFE （15 cases,Group A）,either one abnormal in rHLC,rFLC and IFE （12 cases,Group B）,either two abnormal in rHLC,rFLC and IFE （18 cases, Group C）, all abnormal rHLC, rFLC and IFE （9 cases, Group D）. There was a significant difference in PFS and OS among the A, B, C, D groups （P〈0.05）. Conclusion： Abnormal rHLC can still be detected among IgA MM patients who have achieved VGPR or better response, which indicates poor prognosis. The combined application of HLC,FLC and IFE detection can better monitor prognosis of lgA MM patients.