57例多发性骨髓瘤患者生存及预后因素分析

Survival and Prognosis Analysis of 57 Patients with Multiple Myeloma

目的:探讨初诊多发性骨髓瘤(MM)患者临床相关指标水平和临床分期与患者预后关系,以期能更准确地评估患者病情并指导临床治疗。方法:回顾性分析57例收治的确诊MM患者的年龄、白细胞计数、血小板计数、FISH、ISS分期、kappa轻链水平、lammda轻链水平等指标,通过Kaplan-M eier和Cox回归生存分析模型,对多发性骨髓瘤预后影响因素进行单因素以及多因素分析,评价影响MM患者预后因素。结果:57例患者中位年龄63(29-81)岁,男25例,女32例。中位生存期(OS)37.3个月,中位无进展生存期(PFS)36.3个月,3年生存率73.6%,3年无进展生存率56.1%。单因素分析显示,年龄、白细胞计数、血小板计数、FISH结果、ISS分期、kappa轻链水平、lammda轻链水平以及缓解情况为影响患者预后的危险因素,具有统计学意义。多因素分析显示,kappa轻链水平≥19.4 mg/L以及血小板计数<100×10~9/L为影响多发性骨髓瘤患者预后的独立危险因素。结论:高kappa轻链及低血小板计数的M M患者的临床预后极差,对初治的高kappa轻链及低血小板计数的M M患者治疗方案的选择应加以区别,有益于提高患者生存时间。

Objective： To investigate the relationship of clinical related indicator levels and clinical staging with the prognosis of MM patients so as to more accurately evaluate the disease status and guide the clinical treatment. Method： The clinical indicators including age,WBC and Plt counts,FISH result,ISS staging,Kappa and Lammada light chain levels and so on in 57 cases of MM were analyzed retrospectively; the unvariate and multivatiate analyses of factors influencing the prognosis of MM patients were performed by Kaplan-Meier and Cox regression model; the factors influencing the prognosis of patients were evaluated. Results： Median age of 57 patients including 25 male and 32 female,was 63（29-81） years old,mean OS time was 37. 3 months,mean PFS time was 36. 3 months,3-year OS and PFS were 73. 6% and56. 1% respectively. The unvaviate analysis showed that age,WBC count,Plt count,FISH result,ISS staging,Kappa and lammda light chain levels,and remission were factors influencing the prognosis; the multivatiate analysis showed that the Kappa light chain level≥19. 4 mg/L and Plt count 100 × 109/L were independant risk factors influencing the prognosis of MM patients. Conclusion： The prognosis of MM patients with high Kappa light chian level and low Plt count is very poor,therefore the therapeutic regimens should be selected differentially for this kind of newly diagnosed MM patients so as to enhance the survival time of patients.