摘要
目的:研究多发性骨髓瘤(MM)治疗后出现寡克隆条带和(或)Ig同型转换对疗效和预后评价的意义。方法:回顾性分析2018年8月—2021年7月接受化疗、自体造血干细胞移植(ASCT)、嵌合抗原受体T细胞(CAR-T)治疗的连续入组的72例MM患者的临床资料,应用免疫固定电泳检测M蛋白。结果:8例(11.1%)患者发生异常蛋白条带(APB),APB持续中位时间为2.5(1.1,6.3)个月,诊断MM至出现APB的中位时间为12.5(9.5,34.8)个月,发生APB前的末次治疗至出现APB的中位时间为2.2(0.7,5.7)个月。APB的发生与性别、年龄、ECOG评分、肌酐、血钙、乳酸脱氢酶、血红蛋白、血小板计数、骨髓浆细胞比例、染色体核型等基线特点无关,与β2-微球蛋白和总蛋白水平相关(P<0.05)。APB组≥非常好的部分缓解率明显高于非APB组(100.0%vs 42.2%),差异有统计学意义(P=0.002)。APB组患者的中位生存期为25(95%CI 18~27)个月,非APB组患者的中位生存期为23(95%CI 18~27)个月,2组比较差异无统计学意义。接受化疗和ASCT治疗的患者中,APB组较非APB组的生存时间长,但差异无统计学意义;接受CAR-T细胞治疗的患者中,非APB组的中位生存时间为23(95%CI 20~28)个月,明显低于APB组的54(95%CI 39~54)个月,差异有统计学意义(P=0.028)。结论:在不同方案治疗后出现APB的患者具有更好的疗效;CAR-T细胞治疗后发生APB的患者预后更好。
Objective:To investigate the effect and prognostic evaluation of oligoclonal protein bands and/or immune-globulin(Ig)isotype switch among multiple myeloma(MM)patients.Methods:A total of 72MM patients who received chemotherapy,autologous hematopoietic stem cell transplantation(ASCT),and chimeric antigen re-ceptor T-cell(CAR-T)therapy from August 2018to July 2021were retrospectively analyzed.Monoclonal protein was detected by immunofixation electrophoresis.Results:Abnormal protein band(APB)occurred in 8(11.1%)MM patients.The median duration of APB was 2.5(1.1,6.3)months.The median time from diagnosis and the last treatment of MM to the onset of APB was 12.5(9.5,34.8)and 2.2(0.7,5.7)months,respectively.The oc-currence of APB was not related to baseline characteristics such as sex,age,ECOG score,creatinine,serum calci-um,lactate dehydrogenase,hemoglobin,platelet count,bone marrow plasma cell ratio,chromosome karyotype,but was related to the level ofβ2-microglobulin and total protein(P<0.05).The very good partial response rate in the APB group was significantly higher than that in the non-APB group(100.0%vs 42.2%,P=0.002).The me-dian overall survival in the APB group was 25(95%CI 18-27)months,and in the non-APB group was 23(95%CI 18-27)months,there was no significant difference between the two groups.The median overall survival of pa-tients with APB in the chemotherapy group and the ASCT group seemed longer than that of patients without APB,but there was no significant difference.Among patients who received CAR-T cell therapy,the median over-all survival in patients without APB was 23(95%CI 20-28)months,which was significantly lower than that of 54(95%CI 39-54)months in patients with APB(P=0.028).Conclusion:Patients who had APB have a better re-sponse to chemotherapy,ASCT,or CAR-T cell therapy.The occurrence of APB suggests a better prognosis in MM patients who received CAR-T cell therapy.
作者
曹莉
王莹
曹江
齐昆明
程海
朱锋
孙海英
闫志凌
桑威
李德鹏
李振宇
徐开林
CAO Li;WANG Ying;CAO Jiang;QI Kunming;CHENG Hai;ZHU Feng;SUN Haiying;YAN Zhiling;SANG Wei;LI Depeng;LI Zhenyu;XU Kailin(Institute of Hematology,Xuzhou Medical University,Xuzhou,221000,China;Department of Hematology,Affiliated Hospital of Xuzhou Medical University)
出处
《临床血液学杂志》
CAS
2022年第9期639-644,共6页
Journal of Clinical Hematology
关键词
多发性骨髓瘤
异常蛋白条带
蛋白酶体抑制剂
自体造血干细胞移植
嵌合抗原受体T细胞治疗
multiple myeloma
abnormal protein bands
proteasome inhibitor
autologous hematopoietic stem cell transplantation
chimeric antigen receptor T-cell therapy