多发性骨髓瘤早期复发患者临床特征的分析

Clinical Characteristics of Multiple Myeloma Patients with Early Relapse

目的:分析多发性骨髓瘤(MM)早期复发患者的临床特征。方法:纳入50例早期复发(≤12个月)MM患者,另50例晚期复发MM(>12个月)作为对照组。回顾性分析这100例MM患者从诊断到复发的时间及相关临床资料,并确定与早期复发相关的因素。Kaplan⁃Meier曲线分析整个队列的总生存(OS)时间。应用曲线下面积(AUC)评估循环浆细胞对早期复发的影响。结果:高危细胞遗传学(FISH)(P=0.005)、ISS分期III期(P=0.008)与早期复发相关。对于早期疾病复发的患者,高危FISH在单变量分析中显示出较差的生存结果,并且与晚期复发患者相比,早期复发患者的染色体核型多数出现数量和结构上的异常。循环浆细胞在早期复发组患者中的表达显著增高(P=0.0318)。早期复发组患者对初始治疗的反应较差(P=0.001),预后也显著差于晚期复发的患者(中位OS为38 vs 81个月,P=0.002)。结论:早期复发是MM患者不良预后的标志,此类患者应重点关注,以改善其预后。

Objective:To analyze the clinical characteristics of multiple myeloma(MM)patients with early relapse.Methods:A total of 50 MM patients with early relapse(≤12 months)and 50 matched controls with late relapse(>12 months)were selected.The time from diagnosis to relapse and related clinical data of the 100 patients were retrospectively analyzed,and the factors associated with early relapse were identified.Kaplan⁃Meier curve was used to analyze the overall survival(OS)time of the whole cohort.Area under the curve(AUC)was used to evaluate the effect of circulating plasma cells on early recurrence of the patients.Results:The results showed that high⁃risk cytogenetics(FISH)(P=0.005),and ISS stage III(P=0.008)were associated with early recurrence of the patients.For patients with early relapse,high⁃risk FISH showed poor survival.Compared with the patients with late relapse,most of the chromosome karyotype of patients with early relapse showed quantitative and structural abnormalities.The expression of circulating plasma cells was significantly increased in patients with early recurrence group(P=0.0318).The response to initial treatment was poor in the early recurrence group(P=0.001),and the prognosis was significantly worse than those in the late recurrence group(median OS:38 vs 81 months,P=0.002).Conclusion:Early relapse is a marker poor prognostic in MM patients,and such patients should be focused on the improving their prognosis.