多发性骨髓瘤的临床特征及其预后影响因素

Clinical features and prognostic factors in patients with multiple myeloma

目的:探讨多发性骨髓瘤(MM)患者的临床特征及预后相关影响因素。方法:回顾性分析63例MM患者的临床资料特征,进而分析其预后的相关影响因素。结果:通过Log-Rank分析影响总生存时间(OS)预后的单因素结果显示:与MM患者预后有意义的因素有:年龄、ISS分期、诱导后是否达部分缓解(PR)、三药联合方案、荧光原位杂交(FISH)高危遗传学异常、乳酸脱氢酶(LDH)(P<0.05);COX多因素分析结果显示:FISH存在高危遗传学异常、LDH≥240 U/L与MM患者OS预后有统计学意义(P<0.05)。通过Log-Rank分析影响无进展生存期(PFS)预后的单因素结果显示:与MM患者预后有意义的因素有:年龄、血红蛋白(Hb)、血钙、ISS分期、诱导后是否达PR、FISH高危遗传学异常、LDH(P<0.05);COX多因素分析结果显示:FISH存在高危遗传学异常、LDH≥240 U/L、诱导后未达PR与MM患者PFS有统计学意义(P<0.05)。含硼替佐米的三药联合组与两药联合组比较,客观缓解率(ORR)更高(P=0.000)。结论:存在高危遗传学及高LDH MM患者的预后差。对MM患者而言三药联合化疗较两药联合更获益。

Objective To explore the clinical features and prognostic factors of patients with multiple myeloma(MM).Method The clinical data characteristics of 63 patients with multiple myeloma in our hospital were retrospectively analyzed,and then the relevant influencing factors of myeloma patients were analyzed.Results The single-factor results affecting the prognosis of OS by Log-Rank analysis were as follows:the factors that were meaningful to the prognosis of patients with multiple myeloma were:age,ISS stage,whether PR was reached after induction,three-drug combination regimen,fluorescence in situ hybridization FISH high-risk genetic abnormalities,lactate dehydrogenase(LDH)(P<0.05);The results of COX multivariate analysis showed that fluorescence in situ hybridization FISH had high-risk genetic abnormalities,lactate dehydrogenase(LDH)≥240 U/L and multiple myeloma OS prognosis(P<0.05).The single-factor results affecting the prognosis of PFS by Log-Rank analysis were as follows:the factors that were meaningful with the prognosis of multiple myeloma patients were:age,hemoglobin(Hb),blood calcium,ISS stage,whether PR was reached after induction,fluorescence in situ hybridization FISH high-risk genetic abnormalities,lactate dehydrogenase(LDH)(P<0.05);The results of COX multivariate analysis showed that there were high-risk genetic abnormalities in fluorescence in situ hybrid FISH,lactate dehydrogenase(LDH)≥240 U/L,and PR not reached after induction and MMPFS were statistically significant(P<0.05).The ORR rate of the three-drug combination group containing bortezomib was higher than that in the two-drug combination group(P=0.000).Conclusion Patients with high-risk genetics and high lactate dehydrogenase multiple myeloma have a poor prognosis.For patients with multiple myeloma,three-drug chemotherapy is more beneficial than two-drug combination.