老年多发性骨髓瘤患者临床特征分析

Clinical characteristics of elderly patients with multiple myeloma

目的探讨老年多发性骨髓瘤(MM)患者的临床特征。方法选择复旦大学附属华东医院血液科2012年1月—2020年9月收治的84例MM患者,年龄49~89岁,平均(65.6±9.6)岁,中位发病年龄65.5岁。根据年龄将患者分为老年组(≥60岁,n=60)和非老年组(<60岁,n=24),回顾性分析2组的一般资料、实验室检查及遗传学特征;对完成≥2个化疗疗程的患者进行生存分析。结果2组在免疫分型、D-S分期及骨质破坏方面差异有统计学意义。老年组Ca^(2+)水平低于非老年组(P<0.001),红细胞沉降率高于非老年组(P=0.048),差异均有统计学意义,2组其余实验室检查、骨髓荧光原位杂交检测及染色体核型分析数据差异均无统计学意义(P>0.05)。截至2020年10月30日,完成≥2个化疗疗程的73例患者中位随访时间32.5个月。老年组5年生存率为63.46%(33/52),非老年组为80.95%(17/21),2组差异无统计学意义(χ^(2)=1.339,P=0.247)。老年组中位总生存时间(OS)为49.0个月(95%CT:0.92~5.07),非老年组因死亡病例较少,无法统计中位OS,2组中位OS差异无统计学意义(χ^(2)=2.162,P=0.141)。结论老年MM患者IgG型较为多见,易发生骨质破坏,初诊时多处于疾病晚期。

Objective To explore the clinical characteristics of elderly patients with multiple myeloma(MM).Methods84 patients with MM who were admitted to the Department of Hematology of Huadong Hospital from January 2012 to September2020 were enrolled.They were 49 to 89 years old,with an average age of(65.6±9.6)years and a median age of onset of 65.5 years.According to age,they were divided into elderly group(≥60 years old,n=60)and non-elderly group(<60 years old,n=24).The general data,laboratory examination and genetic characteristics of the two groups were analyzed retrospectively.Survival analysis was performed for patients who completed≥2 courses of chemotherapy.Results There were statistically significant differences in the immunotype,D-S staging and bone destruction between the two groups.The Ca^(2+)level of the elderly group was lower than that of the non-elderly group(P<0.001),and the erythrocyte sedimentation rate level was higher than that of the non-elderly group(P=0.048),the differences were statistically significant.There was no statistically significant difference in the data of other laboratory examinations,bone marrow fluorescence in situ hybridization and chromosome karyotype analysis between the two groups(P>0.05).As of October 30,2020,the median follow-up time of 73 patients who completed≥2 courses of chemotherapy was 32.5 months.The 5-year survival rate was 63.46%(33/52)in the elderly group and 80.95%(17/21)in the non-elderly group.There was no significant difference between the two groups(χ^(2)=1.339,P=0.247).The median overall survival(OS)of the elderly group was 49.0 months(95%CI:0.92-5.07).Because the non-elderly group has fewer deaths,the median OS cannot be calculated.The difference between the two groups was not statistically significant(χ^(2)=2.162,P=0.141).Conclusion The IgG type is more common in elderly patients with MM,they are prone to bone destruction,and most of them are in the late stage of the disease when they are first diagnosed.