多发性骨髓瘤伴髓外病变患者硼替佐米方案治疗效果及生存分析

Efficacy of bortezomib regimen and survival analysis in multiple myeloma patients with extramedullary disease

目的探讨新药时代伴髓外病变(EMD)多发性骨髓瘤患者的近期治疗效果及长期生存情况。方法回顾性分析2015年1月至2020年1月安徽皖北煤电集团总医院诊治的74例多发性骨髓瘤患者资料,其中伴软组织髓外病变(EM-S)患者17例,伴骨旁髓外病变(EM-B)患者9例,无髓外病变(No-EMD)患者48例。分析三组患者接受含硼替佐米方案治疗后的近期疗效、4年无进展生存(PFS)率和总生存(OS)率及其影响因素。结果早期硼替佐米方案诱导治疗3~4个疗程后,EM-S组总体反应率低于No-EMD组和EM-B组[58.8%(10/17)比85.4%(41/48)、100.0%(9/9)],差异均有统计学意义(χ2=13.7,P=0.036;χ2=26.5,P=0.003),而No-EMD组和EM-B组差异无统计学意义(χ2=12.7,P=0.211)。生存分析结果显示,No-EMD组4年PFS率高于EM-S组和EM-B组(41.0%比7.6%、0),差异均有统计学意义(χ2=10.835,P<0.01;χ2=8.276,P=0.004);EM-S组4年OS率低于No-EMD组和EM-B组(16.5%比54.3%、59.3%),差异均有统计学意义(χ2=9.146,P=0.002;χ2=4.066,P=0.044)。结论伴EM-S的多发性骨髓瘤患者硼替佐米方案早期治疗效果、PFS和OS均较差,而EM-B对OS无影响。

Objective To investigate the short-term therapeutic effect and long-term survival of multiple myeloma patients with extramedullary disease(EMD)in the new drug era.Methods The data of 74 patients with multiple myeloma diagnosed and treated in Anhui Wanbei Coal and Electricity Group General Hospital from January 2015 to January 2020 were retrospectively analyzed,including 17 patients with soft tissue infiltration(EM-S),9 patients with bone infiltration(EM-B),and 48 patients without EMD(No-EMD).The short-term efficacy,the 4-year progression-free survival(PFS)rate and overall survival(OS)rate,and their influencing factors in three groups of patients after receiving bortezomib regimen were analyzed.Results After 3-4 courses of early induction therapy of bortezomib regimen,the overall response rate of patients in the EM-S group was lower than that in the No-EMD group and the EM-B group[58.8%(10/17)vs.85.4%(41/48),100.0%(9/9)],and the differences were statistically significant(χ2=13.7,P=0.036;χ2=26.5,P=0.003),while the difference between No-EMD group and EM-B group was not statistically significant(χ2=12.7,P=0.211).Survival analysis showed that the 4-year PFS rate of No-EMD group was higher than that of the EM-S group and EM-B group(41.0%vs.7.6%,0),and the differences were statistically significant(χ2=10.835,P<0.01;χ2=8.276,P=0.004).Meanwhile,the 4-year OS rate of EM-S group was lower than that of the No-EMD group and EM-B group(16.5%vs.54.3%,59.3%),and the differences were statistically significant(χ2=9.146,P=0.002;χ2=4.066,P=0.044).Conclusion The early treatment effect of bortezomib regimen,PFS and OS in multiple myeloma patients with EM-S are poor,while the EM-B has no effect on OS.