"双打击"多发性骨髓瘤患者的临床预后分析

Clinical prognosis analysis of patients with"double hit"multiple myeloma

目的分析并探讨"双打击"多发性骨髓瘤(MM)患者的临床特征及预后。方法研究对象为2010-2016年第二军医大学长征医院诊断的89例MM患者,通过FISH检测染色体变化,基因测序检测TP53基因突变情况,根据最新Walker BA学者提出的"双打击"骨髓瘤定义,分析"双打击"MM患者的临床特征及预后。结果"双打击"MM患者15例(16.85%),中位无进展生存(PFS)时间(8.4个月)和中位总生存(OS)时间(22.2个月)较非"双打击"MM患者的中位PFS时间(14.2个月)和中位OS时间(39.2个月)显著降低(P均<0.05)。多因素预后风险分析显示,"双打击"是影响患者PFS(HR=2.171,95%CI 1.206~3.907,P=0.010)和OS(HR=4.106,95%CI 2.116~7.969,P<0.001)的独立预后不良因素,且"双打击"患者的中位PFS时间(8.4个月)和中位OS时间(22.2个月)分别较R-ISSⅢ期患者的中位PFS时间(11.8个月)和中位OS时间(24.3个月)显著缩短(P均<0.05)。结论"双打击"MM患者预后极差,亟待前瞻性临床研究改善此类患者预后。

Objective To analyze and explore the clinical characteristics and prognosis of patients with"double hit"multiple myeloma(MM).Methods We retrospectively analyzed 89 MM patients in our department of Shanghai Changzheng Hospital from 2010-2016.All patients were assayed by fluorescence in situ hybridization(FISH)and TP53 gene sequencing,based on Dr.Walker BA proposed the"double hit"MM concept,and then the clinical features and prognosis were evaluated.Results In the results,15(16.85%)cases harbored"double hit"showed the median PFS of 8.4 months and the median OS 22.2 months,which was significantly lower than non-"double hit"patients with median PFS 14.2 months and the median OS 39.2 months,respectively(P<0.05).Multivariate analysis displayed that the"double hit"was an independent poor prognostic factor on PFS(HR=2.171,95%CI 1.206-3.907,P=0.010)and OS(HR=4.106,95%CI 2.116-7.969,P<0.001).Moreover,"double hit"MM patients had the higher adverse prognosis risk,which showed the shorter median OS and PFS than stage III of R-ISS patients(PFS 8.4 vs 11.8 months;OS 22.2 vs 24.3 months,P<0.05,respectively).Conclusion Patients with"double hit"MM have a very poor clinical prognosis.Prospective clinical studies are urgently needed to improve these extra high risk patients.