Chao Yao, Fan Li, Gao Xiao-Yun, Ma Yan-Ping
Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China.
Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China,E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2021 Feb;29(1):115-121. doi: 10.19746/j.cnki.issn.1009-2137.2021.01.019.
To investigate the effect of clinical baseline data on prognosis in patients with multiple myeloma (MM) complicated by extramedullary disease (EMD).
The clinical data of 46 MM patients with EMD were retrospectively analyzed. The clinical data and survival prognosis of MM patients in primary EMD group and recurrent EMD group were analyzed. The classified baseline data were expressed by the number of cases (percentage), the χ test was used to compare the two classification data groups. The OS and PFS curves were drawn by multiplication positive limit method (Kaplan-Meier). Log-rank test was used for the univariate analysis of prognosis, and COX proportional risk regression model was used for the multiple factors of prognosis.
β microglobulin≥2.7 g/L, lactic dehydrogenase≥250 U/L, serum calcium≥2.75 mmol/L, plasma cells in bone marrow≥60% were the poor prognostic factors for PFS. Serum calcium≥2.75 mmol/L and the plasma cells in bone marrow≥60% were the poor prognostic factors for OS. Multivariate regression analysis enroling the statistically significant factors in univariate analysis baseline date in factors in showed that plasma cell level≥60% in bone marrow was independent poor prognostic factors for PFS, and serum calcium≥2.75 mmol/L was an independent poor prognostic factor for OS. The IgG type is the most common type of MM complicated by EMD. The remission depth of primary EMD group≥VGPR was lower than that of recurrent EMD group, and there was significant difference between the two groups (P<0.05), and the median OS time of patients with primary EMD group was shorter than that of patients with recurrent EMD group, the difference was statistically significant (P<0.05). The 3-year survival rates of primary EMD group and recurrent EMD group were 10.0% and 34%, respectively, there was no significant difference between the two groups (P>0.05). The 5-year survival rate was 0 and 20%, respectively, there was significant difference between the two groups (P<0.05).
The remission depth of primary EMD group≥VGPR is lower than that of recurrent EMD group，and the OS time of patients in primary EMD group is shorter than that in recurrent EMD group. Bortezomib-based chemotherapy could not improve the prognosis of patients with primary EMD and recurrent EMD, and the prognosis of patients with primary EMD is even worse.
探讨临床基线数据对多发性骨髓瘤（MM）合并髓外病变（EMD）患者预后的影响。
回顾性分析46例MM合并EMD患者的临床资料。分析原发性EMD组和复发性EMD组MM患者的临床资料及生存预后。分类基线数据以例数（百分比）表示，采用χ检验比较两组分类数据。采用乘积极限法（Kaplan-Meier）绘制总生存期（OS）和无进展生存期（PFS）曲线。采用Log-rank检验进行预后单因素分析，采用COX比例风险回归模型进行预后多因素分析。
β2微球蛋白≥2.7 g/L、乳酸脱氢酶≥250 U/L、血清钙≥2.75 mmol/L、骨髓浆细胞≥60%是PFS的不良预后因素。血清钙≥2.75 mmol/L和骨髓浆细胞≥60%是OS的不良预后因素。多因素回归分析纳入单因素分析中有统计学意义的基线日期因素，结果显示骨髓浆细胞水平≥60%是PFS的独立不良预后因素，血清钙≥2.75 mmol/L是OS的独立不良预后因素。IgG型是MM合并EMD最常见的类型。原发性EMD组≥VGPR的缓解深度低于复发性EMD组，两组间差异有统计学意义（P<0.05），原发性EMD组患者的中位OS时间短于复发性EMD组患者，差异有统计学意义（P<0.05）。原发性EMD组和复发性EMD组的3年生存率分别为10.0%和34%，两组间差异无统计学意义（P>0.05）。5年生存率分别为0和20%，两组间差异有统计学意义（P<0.05）。
原发性EMD组≥VGPR的缓解深度低于复发性EMD组，原发性EMD组患者的OS时间短于复发性EMD组。基于硼替佐米的化疗不能改善原发性EMD和复发性EMD患者的预后，且原发性EMD患者的预后更差。
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