游离轻链κ/λ比值正常化是多发性骨髓瘤患者预后良好的有力预测指标。

Normalization of free light chain kappa/lambda ratio is a robust prognostic indicator of favorable outcome in patients with multiple myeloma.

机构信息

Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Chiba, Japan.

出版信息

Eur J Haematol. 2013 Feb;90(2):134-41. doi: 10.1111/ejh.12050. Epub 2013 Jan 7.

DOI:10.1111/ejh.12050

PMID:23210517

Abstract

PURPOSE

To clarify the impact of serum free light chain (sFLC) ratio normalization in patients with multiple myeloma (MM) treated with novel agents.

PATIENTS AND METHODS

Treatment response in 126 consecutive patients over 7 years was assessed by IMWG criteria and sFLC assay.

RESULTS

Thirty-four patients (27%) showed complete response (CR), 37 (29%) very good partial response (VGPR), 39 (31%) partial response (PR), and 16 (13%) stable disease (SD) or less at a median follow-up of 28 months. Fifty-two patients (41%) with sFLC ratio normalization showed superior progression-free survival (PFS) and overall survival (OS) compared to those who did not (3-yr OS, 94% vs. 48%; P < 0.001). This favorable effect of sFLC ratio normalization occurred irrespective of high (>1000 mg/dL) or low (<100 mg/dL) baseline sFLC. Rates of normal sFLC ratio were as follows: CR, 69%; VGPR, 64%; PR, 16%; and SD or less, 0%. OS was significantly superior in patients with than without normal sFCL ratio in respective response groups. Although various factors (advanced age >70, high LDH, ISS stage 3) showed negative prognostic impacts on PFS and OS on univariate analysis, normal sFLC ratio and achievement of CR emerged as the strongest prognostic predictors for longer OS in MM patients on multivariate analysis.

CONCLUSIONS

This study demonstrated the significance of obtaining normal sFLC ratio independent of other clinical variables. Analysis of sFLC ratio could identify the favorable group of patients as well as immunofixation test and support the inclusion of sFLC ratio as part of the response criteria for MM.

摘要

目的

阐明新型药物治疗多发性骨髓瘤（MM）患者时血清游离轻链（sFLC）比值正常化的影响。

方法

通过 IMWG 标准和 sFLC 检测，评估 7 年内 126 例连续患者的治疗反应。

结果

中位随访 28 个月时，34 例（27%）患者达到完全缓解（CR），37 例（29%）患者达到非常好的部分缓解（VGPR），39 例（31%）患者达到部分缓解（PR），16 例（13%）患者病情稳定或更差。52 例（41%）sFLC 比值正常化患者的无进展生存期（PFS）和总生存期（OS）优于未正常化患者（3 年 OS，94% vs. 48%；P<0.001）。sFLC 比值正常化的这种有利影响与基线 sFLC 高（>1000mg/dL）或低（<100mg/dL）无关。正常 sFLC 比值的发生率如下：CR，69%；VGPR，64%；PR，16%；SD 或更差，0%。在各自的反应组中，OS 在 sFCL 比值正常的患者中明显优于无 sFCL 比值正常的患者。虽然在单因素分析中，各种因素（年龄>70 岁、高 LDH、ISS 分期 3 期）对 PFS 和 OS 有负面预后影响，但在多因素分析中，正常 sFLC 比值和达到 CR 是 MM 患者 OS 更长的最强预后预测因素。