IgA型多发性骨髓瘤临床特征和预后分析

Clinical features and prognosis analysis of IgA type multiple myeloma

目的单中心回顾性分析初诊IgA型多发性骨髓瘤(MM)患者的临床表现、疗效、总生存(OS)和无进展生存(PFS)情况。方法收集我医院血液科2009年1月~2018年10月住院的33例IgA型MM患者的临床资料,分析临床特征、不同治疗方案的疗效及生存情况。结果33例IgA型MM临床表现以骨质破坏、贫血、感染最为常见。21例MM存在细胞遗传学异常。采用含硼替佐米方案治疗获得完全缓解(CR)或非常好的部分缓解(VGPR)的比例明显高于传统化疗组。24例患者于首次获得CR后进行微小残留病变(MRD)水平测定,MRD转阴率为66.7%。MRD阴性组复发率明显低于MRD阳性组。33例患者中位随访时间为33月(5~127月),OS为81.3%(26/32),1年及2年PFS为72%和37%。中位生存时间未达到,中位PFS时间是22月。MRD阴性患者中位PFS时间明显长于MRD阳性组。结论IgA型MM骨质破坏易见,易发生贫血,且不良预后的细胞遗传学多见,MRD阳性是其不良预后因素,采用含硼替佐米治疗的方案可提高疗效,改善MM预后。

Objective The clinical manifestation,curative effect,overall survival(OS)and progression-free survival(PFS)of patients with IgA type multiple myeloma(MM)were analyzed retrospectively.Methods The clinical data of 33 patients with IgA type MM hospitalized in the hematology department of the Second Affiliated Hospital of Xi’an Jiaotong University from January 2009 to October 2018 were collected to analyze the clinical characteristics,the efficacy and long-term survival of different treatment plans.Results The most common clinical manifestations of IgA MM were bone destruction,anemia and infection.There was abnormal cytogenetics in 21 patients.The proportion of CR or VGPR obtained by borotezomi therapy was significantly higher than that of traditional chemotherapy group.The level of MRD was determined in 24 patients when the first CR was obtained.66.7%patients were with negative MRD.The recurrence rate of MRD negative group was significantly lower than that of MRD positive group.The median follow-up time of 33 patients was 33 months(5-127).The overall survival rate was 81.3%(26/32).The 1-year and 2-year PFS rate were 72%and 37%.The median survival time was not reached.The median PFS time is 22 months.The median PFS time of MRD negative patients was significantly longer than that of MRD positive group.Conclusion Bone lesions,anemia and cytogenetics of poor prognosis are common in IgA type MM.MRD positive is its adverse prognostic factor.The borotezomi can improve the treatment efficacy and the IgA type MM prognosis.