伴1q21扩增初治多发性骨髓瘤患者疗效及预后的回顾性分析

Retrospective analysis of efficacy and prognosis of newly diagnosed multiple myeloma patients with 1q21 amplification

目的探讨1q21扩增(1q21+)与初治多发性骨髓瘤(newly diagnosed multiple myeloma,NDMM)患者的治疗疗效及预后的关系,以及1q21+在MM危险分层中的优势。方法回顾性分析选择2015年11月至2021年11月于首都医科大学附属北京潞河医院就诊的NDMM患者作为研究对象,采用iFISH技术检测细胞遗传学异常情况,分析1q21+与以硼替佐米为基础的诱导化疗及自体干细胞移植(autologous stem cell transplant,ASCT)疗效及预后的关系,比较MM R2-ISS与R-ISS的分层优势。结果本研究共纳入159例NDMM患者,1q21+患者79例,非1q21+患者80例,其中41例患者接受RVD方案治疗,118例患者接受非RVD方案治疗。在1q21+的患者中,RVD组的完全缓解(complete remission,CR)率高于非RVD组(P<0.001);RVD组中,1q21+的CR率低于非1q21+的患者(P=0.004)。多因素分析显示,1q21+是NDMM患者无进展生存期(progression-free survival,PFS)和总生存期(overall survival,OS)的独立危险因素(P<0.05)。在50例接受ASCT的患者中,1q21+患者的1年、3年的OS率及PFS率均较非1q21+患者更低(P=0.055,0.002)。R2-ISS分期Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期患者的1年PFS率分别为96.3%、95.0%、92.0%和85.4%,3年PFS率分别为88.9%、80.5%、74.0%和61.5%,组间比较差异有统计学意义(P=0.005)。结论1q21+是NDMM患者OS和PFS的独立危险因素,与患者预后不良有关。RVD方案能提高1q21+NDMM患者的缓解深度,ASCT可以改善患者预后,但均不能完全克服1q21+带来的不良影响。在临床中R2-ISS分期在MM危险分层方面具有优越性。

Objective To investigate the relationship between 1q21 amplification(1q21+)and the treatment efficacy and prognosis of the newly diagnosed multiple myeloma(NDMM)patients,and to explore the advantage of 1q21+in the risk stratification of MM.Methods The patients with NDMM treated in Beijing Lu-He Hospital,Capital Medical University,from November 2015 to November 2021 were selected as the research objects.The cytogenetic abnormalities were detected by the interphase fluorescence in situ hybridization(iFISH).The relationship between 1q21+and the efficacy and prognosis of bortezomib based induction chemotherapy and autologous stem cell transplant(ASCT)were analyzed.The stratification advantages of MM R2-ISS and R-ISS were compared.Results A total of 159 NDMM patients were included in this study,79 patients with 1q21+and 80 patients with no 1q21+,of whom 41 patients were treated with RVD regimens and 118 patients with no-RVD regimens.Among 1q21+patients,the complete remission(CR)rate of the RVD group was higher than that of the no-RVD group(P<0.001).In RVD group,the CR rate of 1q21+patients was lower than that of no 1q21+patients(P=0.004).Multivariable analysis showed that 1q21+was an independent risk factor for the progression-free survival(PFS)and the overall survival(OS)in the patients with NDMM(P<0.05).Among the 50 patients receiving ASCT,the 1-year and 3-year OS and PFS rates of 1q21+patients were shorter than those of no 1q21+patients(P=0.055,0.002).The 1-year PFS rates of patients with stageⅠ,Ⅱ,ⅢandⅣof R2-ISS were 96.3%,95.0%,92.0%and 85.4%,respectively,and the 3-year PFS rates were 88.9%,80.5%,74.0%and 61.5%,respectively,with statistical significance(P=0.005).Conclusions 1q21+is an independent risk factor for the OS and PFS in the patients with NDMM,which is associated with poor prognosis.RVD can improve the remission depth of 1q21+NDMM patients,while ASCT can improve the prognosis of patients,but neither of them can completely overcome the adverse effects of 1q21+.Clinically,the R2-ISS has advantages in the MM risk stratification.