血细胞积分对以硼替佐米为基础一线治疗的多发性骨髓瘤患者的预后评估作用

The effect of peripheral blood cell score on the prognosis of multiple myeloma patients treated with bortezomib

目的评估外周血细胞检测结果在以硼替佐米为一线治疗的多发性骨髓瘤(MM)患者中的预后作用。方法回顾性分析2014年1月至2016年12月浙江大学医学院附属第一医院和浙江省舟山医院收治的155例初诊MM患者的临床数据,患者均一线接受以硼替佐米为基础方案的治疗。分析外周血细胞检测结果,包括ANC、单核细胞计数(AMC)、HGB、红细胞平均体积(MCV)、PLT以及其他临床特征对MM患者的预后评估作用。结果AMC(>0.6×10^9/L)、MCV(>99.1fl)以及PLT(<150×10^9/L)明显影响MM患者无进展生存(PFS)和总生存(OS),以上3个因子分别赋值1分,形成血细胞积分。结果显示,64例(41.3%)积分0,57例(36.8%)积分1,32例(20.6%)积分2,2例(1.3%)积分3,4组患者中位PFS时间分别为42.8、26.5、15.8、6.4个月(P<0.001),中位OS时间分别为未达到和48.2、31.1、31.4个月(P=0.001)。多因素分析提示,血细胞积分(2~3对0~1)和骨髓浆细胞比例(>30%对≤30%)为PFS的独立预后因素(HR分别为1.95和1.76),而患者年龄(>65岁对≤65岁)、R-ISS分期(Ⅲ期对Ⅰ~Ⅱ期)和血细胞积分(2~3对0~1)是OS的独立预后因素(HR分别为2.08、2.13和2.12)。结论血细胞积分简单易得,可用于新药时代初治MM患者的预后评估,但仍需扩大病例并进行前瞻性研究进一步明确。

Objective This study aims to evaluate the prognostic effect of peripheral blood cells in multiple myeloma(MM)patients treated with bortezomib.Methods The clinical data of 155 newly diagnosed MM patients in two blood disease treatment centers from January 2014 to December 2016 were retrospectively studied.All patients received bortezomib as the first-line treatment.The results of the peripheral blood cell counts,including absolute neutrophil count,absolute monocyte count(AMC),hemoglobin level,mean corpuscular volume(MCV),and platelet count,and other clinical features were analyzed.Results AMC(>0.6×10^9/L),MCV(>99.1 fl),and platelet count(<150×10^9/L)significantly affected patients’PFS and OS.The above three factors were assigned 1 point,respectively,to form the blood cell score.The analysis showed that 64 cases(41.3%)had a score of 0,57 cases(36.8%)had 1,32 cases(20.6%)had 2,and 2 cases(1.3%)had 3.The median PFS of the four groups were 42.8 m,26.5 m,15.8 m,and 6.4 m,respectively(P<0.001).The median OS were NR,48.2 m,31.1 m,and 31.4 m,respectively(P=0.001).Multivariate analysis suggested that the blood cell score(2-3 vs 0-1)and the proportion of marrow plasma cells(>30%)were independent prognostic factors for PFS(HR=1.95 and 1.76,respectively),while age(>65y vs≤65y),R-ISS stage(3 vs 1-2),and blood cell score(2-3 vs 0-1)were independent prognostic factors for OS(HR=2.08,2.13 and 2.12,respectively).Conclusion As an easy-to-access biomarker,the blood cell score can be used to evaluate the prognosis of newly diagnosed MM patients in the era of new drugs,but it is still necessary to expand the cases and make further confirmation in the prospective study.