多发性骨髓瘤初治时免疫麻痹的临床特征和预后价值

Clinical characteristics and prognostic value of immunoparesis in newly diagnosed multiple myeloma

目的 评估多发性骨髓瘤(MM)患者初治时免疫麻痹的预后价值。方法 以174例含蛋白酶体抑制剂、免疫调节剂等新药为诱导方案的MM患者为研究对象,回顾性分析初治时未受累免疫球蛋白(Igs)水平与预后的相关性。结果 151例(86.7%)在初治时出现了一种或多种未受累Igs的抑制。初治时免疫麻痹患者肿瘤负荷较高、血红蛋白偏低,国际分期系统I期和修订的国际分期系统I期患者免疫麻痹的概率较低。初治时免疫麻痹患者的中位无进展生存期(PFS)和中位总生存期(OS)短于其他患者(PFS:24.7个月vs 73.0个月,P=0.001;OS:58.3个月vs未达到,P=0.013)。诱导治疗后序贯自体造血干细胞移植(ASCT)延长了初治时免疫麻痹患者的PFS和OS(P<0.01)。多因素分析显示,免疫麻痹和诱导后序贯ASCT是MM患者PFS的独立预后因素(P<0.05)。结论 即使在蛋白酶体抑制剂、免疫调节剂等新药治疗的时代,初治时免疫麻痹可能仍是MM患者的独立预后不良因素,这组患者需要尽早接受ASCT等治疗策略来改善预后。

Objective This paper aims to evaluate the prognostic value of immunoparesis in patients with newly diagnosed multiple myeloma(MM).Methods The correlation of uninvolved immunoglobulin(Ig) levels and prognosis was retrospectively analyzed in 174 newly diagnosed MM patients who received induction therapy including novel agents(proteasome inhibitors and/or immunomodulatory agents).Results A total of 151 patients(86.7%) exhibited one or more suppressed uninvolved Igs(known as immunoparesis) at diagnosis.Low immunoparesis at diagnosis was observed in patients with increased tumor burden,lower hemoglobin,and lower probabilities of International Staging System stage I and Revised International Staging System stage I.Median progression-free survival(PFS) and median overall survival(OS) in patients with immunoparesis at diagnosis were significantly shorter than those in the other patients(PFS:24.7 months vs 73.0 months,P=0.001;OS:58.3 months vs not reached,P=0.013).Early autologous hematopoietic stem cell transplantation(ASCT) prolonged PFS and OS in patients with immunoparesis at diagnosis(P<0.01).Multivariate analysis showed that immunoparesis at diagnosis and early ASCT were independently associated with PFS in MM patients(P<0.01).Conclusion In the era of new drugs including proteasome inhibitors and/or immunomodulatory agents,immunoparesis might act as an independent risk factor in newly diagnosed MM patients which need to receive therapeutic strategies such as ASCT as early as possible to improve outcomes.