Yu Xia, Zhang Kai-Ji, Wu Xiu-Jin, Shi Li-Jun, Lin Huo-Zhen
Department of Hematology and Rheumatology, The Fifth People's Hospital of Chengdu, Chengdu 611130, Sichuan Province, China,E-mail：
Department of Hematology and Rheumatology, The First People's Hospital of Chengdu, Chengdu 610071, Sichuan Province, China.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2020 Oct;28(5):1631-1636. doi: 10.19746/j.cnki.issn.1009-2137.2020.05.033.
To investigate the influence of MRD status in newly diagnosed MM patients with VGPR and above after treatment on clinical prognosis.
Clinical data of 210 newly diagnosed MM patients with VGPR and above after treatment in Fifth People's Hospital of Chendu city. from January 2010 to January 2018 were collected and retrospectively analyzed. The patients were divided into 2 groups: group A (152 patients with MRD) and group B (58 patients with MRD). The influencing factors of progression free survival and overall survival of patients were analyzed, and the correlation between MRD status and high-risk cytogenetic abnormalities, treatment plan and response to treatment were evaluated.
There were no significant difference in clinical characteristics between the patients in 2 groups (P＞0.05). Single factor analysis showed that ASCT and MRD status were related with progression free survival of patients with newly diagnosed MM (P＜0.05). Multivariate analysis by Cox regression model showed that MRD persistence was the independent risk factor for progression free survival of patients with newly diagnosed MM (P＜0.05). The cumulative progression free survival rate in 2-year with follow-up of patients in group A was significantly higher than that in B group (P＜0.05). The median progression free survival time and overall survival time of patients with persistent MRD were significantly longer than those of MRD (P＜0.05). The single factor analysis showed that MRD maintenance time was the influencing factor of PFS and OS time of newly diagnosed MM patients (P＜0.05). The cumulative overall survival rate in 2-year with follow-up of patients with MRD maintenance for 6 months was significantly higher than that of patients with MRD maintenance for＜6 months (P＜0.05). The cumulative progression free survival rate and overall survival rate in 2 years with follow-up of patients with MRD maintenance for ≥12 months were significantly higher than those of MRDmaintenance for ＜12 months（P＜0.05）. The median progression free survival time of patients with MRD was significantly longer than that of patients with MRD who had≥ one kind of high-risk cytogenetic abnormality (P＜0.05). The MRD rate of patients received ASCT was significantly higher than that of patients without ASCT (P＜0.05). The median progression free survival time of patients with MRD was significantly longer than that of patients with MRD (P＜0.05). The maintenance time of MRD in patients with bortezomib treatment was significantly longer than that of patients without bortezomib treatment in population with MRD (P＜0.05). The median progression free survival time of patients with bortezomib treatment was significantly longer than patients without bortezomib treatment (P＜0.05).
MRD maintenance in newly diagnosed MM patients with VGPR and above after treatment closely relates with poor long-term prognosis, however, the MRD maintenance time can be used for prognosis evaluation. MRD suggests that patients possess the possibility of early recurrence, and dynamic monitoring of MRD status in treatment can be helpful to clinical determination of treatment opportunity for relapsed MM patients.
探讨初诊多发性骨髓瘤（MM）患者治疗后达到非常好的部分缓解（VGPR）及以上时微小残留病（MRD）状态对临床预后的影响。
收集成都市第五人民医院2010年1月至2018年1月期间210例初诊MM患者治疗后达到VGPR及以上的临床资料，并进行回顾性分析。将患者分为两组：A组（152例MRD阳性患者）和B组（58例MRD阴性患者）。分析患者无进展生存期和总生存期的影响因素，评估MRD状态与高危细胞遗传学异常、治疗方案及治疗反应之间的相关性。
两组患者临床特征差异无统计学意义（P＞0.05）。单因素分析显示，自体造血干细胞移植（ASCT）和MRD状态与初诊MM患者的无进展生存期相关（P＜0.05）。Cox回归模型多因素分析显示，MRD持续存在是初诊MM患者无进展生存期的独立危险因素（P＜0.05）。A组患者随访2年的累积无进展生存率显著高于B组（P＜0.05）。MRD持续存在患者的中位无进展生存期和总生存期显著长于MRD阴性患者（P＜0.05）。单因素分析显示，MRD维持时间是初诊MM患者无进展生存期和总生存期的影响因素（P＜0.05）。MRD维持6个月患者随访2年的累积总生存率显著高于MRD维持时间＜6个月的患者（P＜0.05）。MRD维持≥12个月患者随访2年的累积无进展生存率和总生存率显著高于MRD维持时间＜12个月的患者（P＜0.05）。MRD阴性患者的中位无进展生存期显著长于有≥1种高危细胞遗传学异常的MRD阳性患者（P＜0.05）。接受ASCT患者的MRD率显著高于未接受ASCT的患者（P＜0.05）。MRD阴性患者的中位无进展生存期显著长于MRD阳性患者（P＜0.05）。在MRD阳性人群中，接受硼替佐米治疗患者的MRD维持时间显著长于未接受硼替佐米治疗的患者（P＜0.05）。接受硼替佐米治疗患者的中位无进展生存期显著长于未接受硼替佐米治疗的患者（P＜0.05）。
初诊MM患者治疗后达到VGPR及以上时的MRD维持与长期预后不良密切相关，然而，MRD维持时间可用于预后评估。MRD提示患者有早期复发的可能，治疗中动态监测MRD状态有助于临床确定复发MM患者的治疗时机。
