初治MM合并1q21扩增与否对以硼替佐米为基础诱导化疗方案疗效及患者远期预后的影响

Influence of Combination with 1q21 Amplification or-No in Patients with Newly Diagnosed MM on the Clinical Effecacy of Bortezomib-based induction chemotherapy and Long-Term Prognosis of Patients

目的:探讨初治多发性骨髓瘤(MM)合并1q21扩增与否对以硼替佐米为基础的诱导化疗方案疗效及患者远期预后的影响。方法:选取本院2010年1月-2017年5月收治的初治MM患者共148例,其中未合并1q21扩增70例设为A组,合并1q21扩增78例设为B组,比较2组生存获益及对硼替佐米疗效影响的差异,分析影响患者临床预后的因素。结果:B组患者中位OS和中位PFS均显著短于A组(P<0.05);1q21扩增拷贝数≥3个患者中位OS和中位PFS比较差异无显著性(P>0.05);多因素Cox模型分析提示,初治MM患者OS不良的影响因素分别是ISS分期、Hb水平、β2微球蛋白水平及1q21扩增水平。而PFS的不良影响因素则分别是Hb水平和1q21扩增(P<0.05)。合并1q21扩增患者接受含硼替佐米诱导化疗方案治疗后,深度缓解率显著高于不含硼替佐米诱导的化疗方案(P<0.05);合并1q21扩增的患者含硼替佐米诱导化疗后序贯接受auto-HSCT中位PFS显著长于未行auto-HSCT的患者(P<0.05)。结论:1q21扩增是导致初治MM患者预后不良的独立危险因素;含硼替佐米诱导化疗方案的应用有助于提高合并1q21扩增患者的深度缓解率,而行auto-HSCT巩固治疗能够延长此类患者PFS。

Objective:To investigate the influence of influence of combination with 1q21 amplification or-no in patients with newly diagnosed MM on the clinical effecacy of bortezomib-based induction chemotherapy and long-term prognosis of patients.Methods:148 patients with newly diagnosed MM treated from January 2010 to May 2018 were selected and divided into 2 groups:group A(70 patients)without 1q21 amplification and group B(78 patients)with 1q21 amplification;and the survival benefit and influence on clinical efficacy of bortezomib were compared between 2 groups,and the factors influencing clinical prognosis in the patients with newly diagnosed MM were analyzed.Results:The median PFS and OS of patients in B group were significantly shorter than those in group A(P<0.05).There was no significant difference in the median OS and PFS between patients with 1q21 amplification copies number=3 and>3(P>0.05).Multivariate Cox model analysis indicated that the adverse factors for OS were ISS staging,Hb levels,β2 microglobulin levels and 1q21 amplification respectively,and the adverse factors for PFS were Hb levels and 1q21 amplification respectively in patients with newly diagnosed MM(P<0.05).The very good partial remission rate of newly diagnosed MM patients with 1q21 amplification and bortezomib-based induction chemotherapy were significantly higher than that in the patients without bortezomib-based induction chemotherapy(P<0.05).The median PFS time of newly diagnosed MM patients with 1q21 amplification and auto-HSCT after bortezomib-based induction chemotherapy was significantly longer than that of patients without auto-HSCT(P<0.05).Conclusion:1q21 amplification should be the independent risk factor for poor prognosis of patients with newly treated MM.The application of bortezomibcontaining induction chemotherapy in patients with 1q21 amplification can efficiently improve the remission rate,while auto-HSCT consolidation therapy may prolong patients’PFS.