Chen Z, Xia Y, Guo R, Zhang R, Qiu H R, Jin Y Y, Li J Y, Chen L J
Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China.
Zhonghua Xue Ye Xue Za Zhi. 2022 May 14;43(5):408-413. doi: 10.3760/cma.j.issn.0253-2727.2022.05.010.
To investigate the influence of the number of high-risk cytogenetic abnormalities (HRCA) on the clinical characteristics and prognosis of patients with newly diagnosed multiple myeloma (MM) . A total of 360 patients with newly diagnosed MM admitted to Jiangsu Province Hospital between November 2013 and September 2020 were included in this study. Cytoplasmic light chain immunofluorescence with fluorescence in situ hybridization (cIg-FISH) was used to detect HRCA. Cytogenetic abnormalities were combined with clinical characteristics and outcomes for further analysis. Among the 360 patients, 120 patients (33.3%) presented with no HRCAs, and 175 (48.6%) , 61 (16.9%) , and four (1.1%) patients had one, two, and three HRCA (s) , respectively. Patients were divided into three groups, including the no-HRCA group, one-HRCA group, and ≥two-HRCA group, according to the number of HRCAs. There were significant differences in the R-ISS stage, hemoglobin level, albumin level, and the proportion of bone marrow plasma cells among the three groups (<0.05) . The COX proportional-hazards model identified extramedullary disease (=0.018) , HRCA ≥ 2 (=0.001) , and absence of autologous hematopoietic stem cell transplantation (<0.001) as independent risk factors for progression free survival (PFS) and identified lactate dehydrogenase (LDH) level ≥ 220 U/L (<0.001) , HRCA ≥2 (=0.001) , and absence of autologous hematopoietic stem cell transplantation (=0.005) as independent risk factors for overall survival (OS) . The median PFS was 28 months, 22 months, and 14 months (=0.005) for the three cohorts, and their OS was not reached,60 months, and 30 months (=0.001) , respectively. HRCA ≥ 2 is an independent risk factor for decreased survival in patients with newly diagnosed MM. More HRCAs result in heavier tumor burden, as well as a higher risk of disease progression and death.
探讨高危细胞遗传学异常(HRCA)数量对新诊断的多发性骨髓瘤(MM)患者临床特征及预后的影响。本研究纳入了2013年11月至2020年9月期间在江苏省人民医院收治的360例新诊断的MM患者。采用细胞质轻链免疫荧光联合荧光原位杂交(cIg-FISH)检测HRCA。将细胞遗传学异常与临床特征及结局进行综合分析。360例患者中,120例(33.3%)无HRCA,175例(48.6%)有1个HRCA,61例(16.9%)有2个HRCA,4例(1.1%)有3个HRCA。根据HRCA数量将患者分为三组,即无HRCA组、1个HRCA组和≥2个HRCA组。三组间的R-ISS分期、血红蛋白水平、白蛋白水平及骨髓浆细胞比例存在显著差异(<0.05)。COX比例风险模型确定髓外病变(=0.018)、HRCA≥2(=0.001)及未进行自体造血干细胞移植(<0.001)为无进展生存期(PFS)的独立危险因素,确定乳酸脱氢酶(LDH)水平≥220 U/L(<0.001)、HRCA≥2(=0.001)及未进行自体造血干细胞移植(=0.005)为总生存期(OS)的独立危险因素。三组患者的中位PFS分别为28个月、22个月和14个月(=0.005),OS分别为未达到、60个月和30个月(=0.001)。HRCA≥2是新诊断MM患者生存降低的独立危险因素。更多的HRCA导致更重的肿瘤负荷,以及更高的疾病进展和死亡风险。