化疗后免疫状态的改变对初诊多发性骨髓瘤患者的预后价值

Prognostic Value of Immune Status Changes after Chemotherapy in Patients with Newly Diagnosed Multiple Myeloma

目的:探讨化疗后免疫状态的改变对初诊多发性骨髓瘤(multipe myeloma,MM)患者的预后意义。方法:收集并回顾性分析2011年4月至2017年12月兰州大学第二医院血液科收治的99例多发性骨髓瘤患者临床资料。用淋巴细胞数与单核细胞数比值(lymphocyte/monocyte ratio,LMR)的变化来反应免疫状态的改变。分析患者的年龄、性别、MM分型、血红蛋白(hemoglobin,Hb)、β2-微球蛋白(β2-microglobulin,β2-MG)、乳酸脱氢酶(lactic dehydrogenase,LDH)、白蛋白(albumin,ALB)、血肌酐(Serum creatinine,Scr)及治疗方案等临床因素与LMR变化之间的关系,探讨上述指标对初诊MM患者的预后价值。亚组间生存率的比较通过Kaplan-Meier曲线并采用Logrank法检验。采用COX比例风险回归模型进行预后的单因素以及多因素分析。应用配对样本Wilcoxon检验来比较淋巴细胞绝对计数(absolute lymphocyte count,ALC)、淋巴细胞绝对计数(absolute monocyte count,AMC)以及LMR在治疗前、后的变化,并用Logistic回归模型来分析影响LMR变化的临床因素。结果:在治疗1个月后,ALC的中位数从1.25(0.84-1.81)×10^9/L升高至1.39(1.02-1.9)×10^9/L(P=0.029);AMC的中位数从0.37(0.23-0.47)×10^9/L降低至0.29(0.2-0.44)×10^9/L(P=0.026);LMR的中位数从3.552(2.405-5.208)升高至5.138(3.22-6.471)(P=0.002)。多因素生存分析显示,LMR的升高(HR 0.459,95%CI 0.241-0.875,P=0.018)和LDH≥240(U/L)(HR 2.368,95%CI 1.123-4.995,P=0.024)是影响MM患者预后的独立影响因素。结论:治疗后LMR水平的升高预示初诊MM患者将拥有较长的生存时间。联合LMR不但可以反映治疗对机体免疫状态的影响,而且可以更好的预测MM患者的预后。

Objective:To investigate the prognostic significance of immune changes in patients with newly diagnosed multiple myeloma(MM)after chemothrapy.Methods:The clinical data of 99 patients with multiple myeloma received treatment in Department of Hematology,Lanzhou University Second Hospital from April 2011 to December 2017 were collected and retrospectively analyzed.The change of immune status was defined by changes of lymphocyte/monocyte ratio(LMR)level.The prognosis value of age,sex,typing,hemoglobin(Hb),β2-microglobulin(β2-MG),lactate dehydrogenase(LDH),albumin(albumin,ALB)and LMR changes were investigated in patients with newly diagnosed MM,and the relationship between above mentioned factors and changes of LMR was also explored.Overall survival rate between different subgroups was compared by using Kaplan-Meier curves and detected by Log-rank tests.Univariate and multivariate analysis of prognosis was performed by using the COX proportional hazards regression model.Paired samples Wilcoxon test were used to compare changes in ALC,AMC and LMR before and after chemotherapy,and logistic regression was used to investigate the clinical factors that affect the changes of LMR.Results:The median value of ALC increased from 1.25(0.84-1.81)×10^9/L to 1.39(1.02-1.9)×10^9/L(P=0.029)after treated for 1 month;the median value of AMC decreased from 0.37(0.23-0.47)×10^9/L to 0.29(0.2-0.44)×10^9/L(P=0.026),and the median value of LMR increased from 3.552(2.405-5.208)to 5.138(3.22-6.471)(P=0.002).Multivariate survival analysis showed that increasing of LMR(HR 0.459,95%CI 0.241-0.875,P=0.018)and LDH(HR 2.368,95%CI 1.123-4.995,P=0.024)were considered to be the independent factors affecting the prognosis of MM patients.Conclusion:The increasing of LMR level after treatment indicates a longer survival time of newly prognostic MM patients.Combination with LMR can not only reflect the effect of treatment on the immune status,but also predict the prognosis of MM patients much better.