66例IgG型多发性骨髓瘤患者初诊时IgG水平与疗效及预后的相关性分析

Correlation of IgG Levels at Initial Diagnosis with Clinical Efficacy and Prognosis in 66 Patients with IgG Multiple Myeloma

目的:分析IgG型多发性骨髓瘤(MM)患者初诊时血清IgG水平与疗效及预后的关系。方法:收集本院血液科于2012年9月至2018年10月收治的66例初诊IgG型MM患者的临床资料,根据初诊时血清IgG水平分为A组(IgG≤64g/L,n=41)和B组(IgG>64g/L,n=25)。根据接受的化疗方案2组又分为沙利度胺(TM,n=35)组和硼替佐米(BTZ,n=31)组,分别分析2组间临床疗效和无进展生存期、总生存期及影响因素。结果:A组总体疗效率(ORR)和深度缓解率(CR+VGPR)均显著优于B组(P=0.008,P=0.036)。B组的BTZ组ORR显著优于TM组(P=0.028),A组的TM组ORR优于B组的TM组(P=0.048),其深度缓解率优于B组的TM组(P=0.05)。B组中高危细胞遗传学(HRC)患者显著多于A组(P=0.022)。Spearman相关分析显示,IgG水平与血白蛋白(Alb)水平呈显著负相关(r=-0.449,P=0.000),与血红蛋白(Hb)水平呈显著负相关(r=-0.608,P=0.000),与骨髓浆细胞(BMPC)水平呈正相关(r=0.328,P=0.007)。生存分析结果显示,A组的PFS显著优于B组(P=0.015);A组的OS率显著优于B组(P=0.049);TM组与BTZ组的PFS与OS均无显著差异(PFS:P=0.695,OS:P=0.325)。多因素生存分析结果显示,临床最大疗效≥VGPR和SRCs是影响IgG型MM患者预后的独立影响因素。结论:IgG型MM患者初诊时IgG>64g/L是影响PFS和OS的不良预后因素,血清IgG水平越高,细胞遗传学高危风险越大,疗效及预后就越差。

Objective:To explore the IgG levels of newly diagnosed IgG-type multiple myeloma (MM) patients and analyze the relationship between the IgG levels and clinical efficacy and prognosis. Methods:The clinical data of 66 newly diagnosed IgG-type MM patients in our hospital from September 2012 to October 2018 were collected. These 66 patients were divided into group A (IgG≤ 64 g/L,n=41),and group B (IgG > 64 g/L,n=25),then the MM patients in 2 groups were divided into 2 subgroups thalidomide (TM)-treated group (n=35) and bortezomib (BTZ)-treated group (n=25) according to therapeutic regimens. The climical efficacy,PFS and OS time as well as the factors affecting prognosis of patients were compared and analyzed. Results:The overall response rate (ORR) and CR+VGPR rate in group A were better than those in group B (P=0.008,P=0.036),the ORR of BTZ-treated group in group B was significantly better than that of TM-treated group (P=0.028),while the ORR of TM-treated group in group A was better than that of TMtreated group in group B (P=0.048),the CR+VGPR rate was better than that of TM-treated group in group B (P < 0.05). The number of patients with high risk cytogenetics (HRC) in group B was much more than that in group A (P=0.022). Spearman correlation analysis showed that serum IgG levels negatively correlated with albumin (r=-0.449,P=0.000) and hemoglobin (r=-0.608,P=0.000),and positively correlated with bone marrow plasma cells (r=0.328,P=0.007). Survival analysis showed that the PFS in group A was significantly better than that in group B (P=0.015),and the OS in group A was better than that in group B (P=0.049),but there was no significant difference in PFS and OS between TM group and BTZ group (PFS:P=0.695,OS:P=0.3250). Cox multivariate regression analysis showed that the ≥ VGPR and standard-risk cytogenetics were independent prognostic factors for PFS and OS. Conclusion:IgG> 64g/L in patients with newly diagnosed IgG-type MM is a poor prognostic factor affecting PFS and OS. The higher level of serum IgG at the initial diagnosis,the higher the risk of HRCs,and the worse clinical efficacy and prognosis of patients.