39例50岁以下多发性骨髓瘤患者临床特征与预后分析

Analysis of clinical characteristics and prognosis of 39 patients with multiple myeloma under 50 years old

目的:探讨50岁以下多发性骨髓瘤(multiple myeloma,MM)患者的临床表现及预后。方法:回顾性分析2011年11月—2022年11月本院收治的39例50岁以下初治MM患者的临床资料及实验室指标,探索影响生存和预后的因素,并与既往已发表的国外研究数据进行比较。结果:50岁以下MM患者占同时期初治MM患者的21.5%(39/181),该部分患者国际分期系统(ISS)Ⅲ期比例为46.2%(18/39)、轻链型占30.8%(12/39)、贫血占56.4%(22/39)、肾功能不全占30.8%(12/39)。中位随访36(3~160)个月,中位无进展生存期为35个月,总生存期未达到。单因素分析显示,血钙、乳酸脱氢酶、自体造血干细胞移植和最佳缓解深度均是无进展生存期和总生存期的影响因素(P<0.05)。多因素分析显示,乳酸脱氢酶升高(HR=7.356,95%CI 1.288~41.998,P=0.025)是总生存期预后不良的独立影响因素。结论:与国外数据相比,本中心年轻初治MM患者的比例更高,且ISSⅢ期、轻链型、贫血及肾功能不全的比例亦更高。患者预后大多较好,乳酸脱氢酶是总生存期预后不良的独立危险因素。

Objective To investigate the clinical characteristics and prognosis of young patients(younger than 50 years of age)with multiple myeloma(MM).Methods The clinical characteristics and outcome of 39 newly diagnosed MM patients younger than 50 years of age admitted to our hospital from November 2011 to November 2022 were retrospectively analyzed,and the factors that affected survival and prognosis compared with previously published foreign research data were evaluated.Results Patients under 50 years old accounted for 21.5%(39;181)of MM patients with initial treatment at the same period,and the proportion of these patients in international stageⅢsystem was 46.2%(18;39),light chain type accounted for 30.8%(12;39),anemia accounted for 56.4%(22;39),and renal insufficiency accounted for 30.8%(12;39).Patients were followed-up for the median period of 36(3-160)months.The median progression-free survival was 35 months,and the median overall survival was not attained.Univariate analysis showed that calcium,lactic dehydrogenase,autologous hematopoietic stem cell transplantation and the best of response were all influencing factors for the progression-free survival and the overall survival(P<0.05).Multivariate analysis showed that elevated lactic dehydrogenase was an independent influencing factor for poor overall survival prognosis(HR=7.356,95%CI 1.288-41.998,P=0.025).Conclusion Compared with previously published foreign research data,the proportion of MM in young patients may be higher,and the proportion of ISS stageⅢ,light chain type,anemia and renal insufficiency is higher,and the prognosis is better.