多发性骨髓瘤患者出现寡克隆条带的临床意义

The Clinical Significance of Oligoclonal Bands in Patient with Multiple Myeloma

目的:探讨多发性骨髓瘤(MM)患者出现寡克隆条带(oligoclonal bands,OB)的临床价值。方法:回顾性分析中国医学科学院血液病医院2013年1月到2019年12月收治的624例初治MM患者的临床资料,其中OB患者30例,分析并比较OB与非OB患者的临床特点、治疗疗效及生存情况。结果:接受自体造血干细胞移植(ASCT)的患者中有11.8%(22/187例)的患者出现了OB,未接受ASCT患者中只有1.8%(8/437例)(P=0.000)。在ASCT患者中,患者出现OB的中位时间为距离移植3.2(0.6-10.5)个月。寡克隆条带M蛋白类型通常为IgGκ、IgGλ、IgMλ和λ轻链型。出现OB时,90%的患者疗效评估为完全缓解(CR)及以上。OB和非OB两组患者在疾病分期、肿瘤负荷及遗传学异常上无统计学差异。整体患者中,OB患者的预后显著优于非OB患者,OB患者表现出更深层次的疾病缓解(CR率、MRD-率显著更高及MRD-持续时间长)。在接受ASCT的患者中,OB患者较非OB患者表现出更早的免疫恢复,但两组治疗反应深度相似,生存时间上无统计学差异。更早的免疫重建并没有转化为更好的生存,提示OB患者预后更好可能主要与获得更深且持久的缓解有关,而非早期免疫重建。对接受ASCT且获得MRD-的患者进一步分析发现,OB患者并没有额外的生存获益。结论:OB患者的预后更好可能与其获得更深层次的治疗反应有关,与早期免疫重建关系不明显。OB的出现仅仅是患者获得深层次缓解及早期免疫重建的标志,自身并没有生存增益。

Objective:To investigate the clinical value of oligoclonal bands(OB)in patients with multiple myeloma(MM). Methods:The laboratory test and clinical data of624newly diagnosed MM patients admitted to Blood Diseases Hospital of Chinese Academy of Medical Sciences from January2013to December2019were retrospectively analyzed,including30patients with OB,and the clinical characteristics,treatment effects and survival of OB and non-OB patients were analyzed and compared. Results:OB occurred in11.8%(22/187)of patients who received autologous stem cell transplantation(ASCT)and only1. 8%(8/437)of patients who did not receive ASCT(P= 0.000). The median time to the appearance of oligoclonal bands was3.2(0.6-10.5)months after transplantation. The M protein types of oligoclonal bands mainly include IgGκ,IgGλ,IgMλandλlight chains. In the presence of oligoclonal bands, 90% of patients were evaluated as complete remission(CR)and above. There were no statistically significant differences in disease stage,tumor burden,and genetic abnormalities between OB and non-OB patients. Among the all patients,the prognosis of OB patients was significantly better than that of non-OB patients,and OB patients showed deeper disease remission(significantly higher CR rate,MRD negative rate,and longer MRD negative duration). Among patients who underwent ASCT,OB patients showed earlier immune recovery,but the depth of treatment response and survival outcomes were similar between OB and non-OB patients,it was no statistically difference. Although OB patients showed earlier immune reconstitution,this did not translate into better survival,suggesting that the better prognosis of OB patients was mainly related to deeper and durable remission rather than early immune reconstitution. Further analysis in patients who received ASCT and obtained MRD negative indicated that there was no additional survival benefit in patients with OB. Conclusion:The better prognosis of OB patients may be related to the deeper treatment response,but not to the early immune reconstitution. The appearance of OB is only a sign of deep remission and early immune reconstitution in patients,it cannot be translated into survival benefit of MM patients.