以梅奥骨髓瘤分层及风险调适治疗共识指南分层的中高危多发性骨髓瘤患者遗传学特点及预后影响因素分析

Genetic characteristics and prognostic influencing factors of middle-high-risk multiple myeloma patients stratified based on Mayo Stratification of Myeloma and Risk-Adapted Therapy consensus guidelines

目的以梅奥骨髓瘤分层及风险调适治疗(mSMART)共识指南分层为基础,探讨中高危多发性骨髓瘤(MM)患者的遗传学特点及预后影响因素。方法收集福建省立医院2009年6月至2017年10月住院MM患者179例,排除无法进行mSMART分层患者,最终纳入49例。依据mSMART分层标准将患者分为低危组(24例)和中高危组(25例),分析两组遗传学特点,探讨mSMRAT分层与患者临床特征的关系。采用Kaplan-Meier法进行生存分析,并行log-rank检验;logistic回归法分析中高危患者的预后影响因素。结果低危组中CSK1B基因扩增发生率最高(41.7%,10/24),中高危组中RB1基因缺失发生率最高(88.0%,22/25)。低危和中高危组患者骨质破坏、高钙血症、肾损害、贫血、β2微球蛋白异常、清蛋白异常、乳酸脱氢酶异常、浆细胞比例异常发生率比较,差异均无统计学意义(均P>0.05)。生存分析显示,中高危组中位总生存时间为23.19个月,低于低危组的39.71个月(P=0.043)。多因素logistic回归分析发现贫血及骨质破坏是影响中高危组患者预后的危险因素(P=0.044,P=0.002)。结论mSMART分层为中高危的患者提示预后不良,贫血及骨质破坏是影响中高危患者预后的危险因素。

Objective To investigate the genetic characteristics and prognostic influencing factors of the middle-high-risk patients with multiple myeloma (MM) based on Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) consensus guidelines. Methods A total of 179 hospitalized MM patients in Fujian Provincial Hospital from June 2009 to October 2017 were collected. Eventually, 49 patients were included except for the patients who were unable to perform mSMART stratification. According to the mSMART stratification criteria, the patients were divided into low-risk group (24 cases) and middle-high-risk group (25 cases). The genetic characteristics of the two groups were analyzed to explore the relationship between mSMART stratification and clinical features. Kaplan-Meier method and log-rank test were used to make survival analysis;logistic regression analysis was used to analyze the prognostic influencing factors in high-risk patients. Results The incidence of CSK1B gene amplification was the highest in the low-risk group (41.7%, 10/24), while in the middle-high-risk group, the incidence of RB1 gene deletion was the highest (88.0%, 22/25). In the low-risk group and the middle-high-risk group, there were no statistical differences in bone destruction, hypercalcemia, renal damage, anemia,β2 microglobulin abnormality, albumin abnormality, lactate dehydrogenase abnormality, and plasma cell ratio abnormality (all P > 0.05). Survival analysis showed that the median survival time of the middle-high-risk group was lower than that of the low-risk group (23.19 months vs. 39.71 months, P = 0.043). Multivariate logistic regression analysis found that anemia and bone destruction were risk prognostic influencing factors for mSMART stratification as a middle-high-risk group (P = 0.044, P = 0.002). Conclusion mSMART stratification could indicate the poor prognosis for the patients with middle-high-risk, and the anemia and bone destruction are risk prognostic influencing factors for patients with middle-high-risk stratification.