硼替佐米为主化疗方案治疗多发性骨髓瘤患者临床疗效及生存影响因素分析

Analysis on the Clinical Effect and Survival Factors of Bortezomib Based Chemotherapy in Patients with Multiple Myeloma

目的:探讨硼替佐米为主的化疗方案治疗多发性骨髓瘤(MM)的临床疗效,分析影响患者预后的相关因素.方法:回顾性分析80例接受硼替佐米为主化疗方案治疗的MM患者临床资料.评价其疗效,采用Kaplan-Meier法进行生存分析,估计患者3年总生存(OS)率及无进展生存(PFS)率,并采用Log-rank检验及Cox比例风险回归模型对可能影响预后的因素进行单因素分析及多因素分析.结果:80例患者,总有效为82.5%,CR率为43.8%.中位随访时间29(2~91)个月,全组3年OS为76.4%,PFS率为57.8%.单因素分析显示,MM患者的预后与年龄、ISS分期、白细胞计数、同型半胱氨酸(Hcy)水平、血小板计数(PLT)、乳酸脱氢酶水平、Kappa轻链水平、FISH结果、疗效情况有关(P<0.05);而与性别、DS分期、血红蛋白水平、血肌酐水平、尿素氮水平、骨髓浆细胞数、MM类型、白蛋白、染色体情况、骨损害、肾损害等无关(P>0.05).Cox多因素分析显示,PLT≤100×109L-1、Hcy≥22μmol/L、Kap-pa轻链水平≥19.4mg/L是影响MM患者预后(OS及PFS)的独立危险因素(P<0.05),且疗效≥VGPR是预后(OS)的有益因素(P<0.05).结论:硼替佐米为主的化疗方案治疗MM疗效显著,PLT、Hcy及Kappa轻链水平是患者影响患者生存的独立危险因素,而疗效≥VGPR是生存的有益因素.

Objective:To investigate the clinical efficacy of bortezomib-based chemotherapy regimen in the treatment of multiple myeloma(MM)and to analyze the related factors affecting the prognosis of patients.Methods:The clinical data of 80 patients with MM who received bortezomib-based chemotherapy regimen were retrospectively analyzed.The efficacy was evaluated,and Kaplan-Meier method was used for survival analysis,and the 3-year overall survival(OS)rate and progression-free survival(PFS)rate were estimated.Log-rank test and Cox proportional hazard regression model were used for univariate analysis and multivariate analysis on factors that might affect prognosis.Results:Of the 80 patients,the total effective rate was 82.5%and the CR rate was 43.8%.The median follow-up time was 28(2~89)months,and the 3-year OS of the whole group was 76.4%,and the PFS rate was 57.8%.Univariate analysis showed that prognosis of MM patients was related to age,ISS staging,white blood cell count,homocysteine(Hcy)level,platelet count(PLT),lactate dehydrogenase level,Kappa light chain level,FISH results,efficacy and presence or absence of HSCT treatment(P<0.05),and was not related to gender,DS staging,hemoglobin level,serum creatinine level,urea nitrogen level,bone marrow plasma cell number,MM type,albumin,chromosome condition,bone damage and kidney damage(P>0.05).Cox multivariate analysis showed that PLT≤100×109L-1,Hcy≥22μmol/L and Kappa light chain level≥19.4mg/L were independent risk factors for the prognosis(OS and PFS)of MM patients(P<0.05),and efficacy≥VGPR was a beneficial factor for prognosis(OS)(P<0.05).Conclusion:Bortezomib-based chemotherapy regimen has significant efficacy in the treatment of MM.PLT,Hcy and Kappa light chain level are independent risk factors for survival of patients,and efficacy≥VGPR is a beneficial factor for survival.