PAFAH1B3表达水平与多发性骨髓瘤患者自体造血干细胞移植后疾病进展风险的相关性

Correlation between PAFAH1B3 Expression Level and Risk of Disease Progression After Autologous Hematopoietic Stem Cell Transplantation in Multiple Myeloma Patients

目的:探讨接受自体造血干细胞移植(AHSCT)治疗的多发性骨髓瘤(MM)患者骨髓CD138^(+)细胞中血小板激活因子乙酰水解酶1B3(platelet-activating factor acetylhydrolase 1B3,PAFAH1B3)基因表达水平与2年内预后之间的相关性。方法:选取2014年5月至2019年5月间于南通大学第一、第二附属医院就诊的147例行AHSCT治疗的MM患者作为研究对象,检测患者骨髓CD138^(+)细胞中PAFAH1B3 mRNA的表达水平,并将随访2年间疾病进展或死亡者纳入进展组,其余纳入预后良好组。比较两组患者的临床资料和PAFAH1B3 mRNA表达水平,以入组患者PAFAH1B3 mRNA表达水平中位数为界将患者分为PAFAH1B3高表达组和低表达组,采用Kaplan-Meier法比较两组患者的无进展生存率(PFSR)。应用单因素分析和多因素COX回归分析法分析患者2年内预后的相关因素。结果:随访结束时共有13/147例患者失访,最终进展组纳入44例,预后良好组纳入90例。进展组年龄高于预后良好组,移植后达CR^(+)VGPR患者比例低于预后良好组,两组ISS分期例数分布差异有统计学意义(均P<0.05);进展组PAFAH1B3 mRNA表达水平和LDH>250 U/L患者比例均高于预后良好组,PLT值低于预后良好组(均P<0.05);PAFAH1B3高表达组2年PFSR显著低于低表达组(log rankχ^(2)=8.167,P=0.004);LDH>250 U/L(HR=3.389,P=0.010)、PAFAH1B3 mRNA表达水平(HR=50.561,P=0.001)和ISSⅢ期(HR=1.000,P=0.003)为患者预后的独立危险因素,ISSⅠ期(HR=0.133,P=0.001)为患者预后的独立保护因素。结论:接受AHSCT治疗的MM患者骨髓CD138^(+)细胞中PAFAH1B3 mRNA表达水平与预后相关,检测PAFAH1B3 mRNA表达水平对预测患者的PFSR和预后分层具有一定意义。

Objective:To investigate the association between the expression level of platelet-activating factor acetylhydrolase 1B3(PAFAH1B3)gene in bone marrow CD138^(+)cells of patients with multiple myeloma(MM)treated with autologous hematopoietic stem cell transplantation(AHSCT)and the prognosis within 2 years.Methods:147 MM patients treated with AHSCT in The First and The Second Affiliated Hospital of Nantong University from May 2014 to May 2019 were included in the study.Expression level of PAFAH1B3 mRNA in bone marrow CD138^(+)cells of the patients was detected.Patients with disease progression or death during 2 years of follow-up were included in progression group,and the rest were included in good prognosis group.After comparing the clinical data and PAFAH1B3 mRNA expression levels of the two groups,the patients were divided into high PAFAH1B3 expression group and low PAFAH1B3 expression group based on the median PAFAH1B3 mRNA expression level of the enrolled patients.Progression-free survival rate(PFSR)between the two groups was compared by the Kaplan-Meier method.The related factors of prognosis within 2 years were analyzed by univariate analysis and multivariate COX regression analysis.Results:At the end of follow-up,there were 13 patients lost to follow-up.Finally,44 patients were included in the progression group and 90 patients were included in the good prognosis group.Age in the progression group was higher than that in the good prognosis group,the proportion of patients with CR^(+)VGPR after transplantation in the progression group was lower than that in the good prognosis group,and there was a statistical difference between two groups in the cases distribution of ISS stage(all P<0.05).PAFAH1B3 mRNA expression level and the proportion of patients with LDH>250U/L in the progression group were higher than those in the good prognosis group,and platelet count in the progression group was lower than that in the good prognosis group(all P<0.05).Compared with the low PAFAH1B3 expression group,the 2-year PFSR of the high PAFAH1B3 expression group was significantly lower(log-rankχ2=8.167,P=0.004).LDH>250U/L(HR=3.389,P=0.010),PAFAH1B3 mRNA expression(HR=50.561,P=0.001)and ISS stageⅢ(HR=1.000,P=0.003)were independent risk factors for prognosis in MM patients,and ISS stageⅠ(HR=0.133,P=0.001)was independent protective factor.Conclusion:The expression level of PAFAH1B3 mRNA in bone marrow CD138^(+)cells is related to the prognosis of MM patients treated with AHSCT,and detecting PAFAH1B3 mRNA expression can bring some information for predicting PFSR and prognostic stratification of patients.