Liu Jia-Hui, Fan Hui-Shou, Yan Wen-Qiang, Xu Jing-Yu, Li Ling-Na, Xu Yan, Yi Shu-Hua, Zou De-Hui, Qiu Lu-Gui, An Gang
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College，Tianjin 300020, China.
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College，Tianjin 300020, China,E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2022 Oct;30(5):1453-1463. doi: 10.19746/j.cnki.issn.1009-2137.2022.05.023.
To investigate the clinical value of oligoclonal bands (OB) in patients with multiple myeloma (MM).
The laboratory test and clinical data of 624 newly diagnosed MM patients admitted to Blood Diseases Hospital of Chinese Academy of Medical Sciences from January 2013 to December 2019 were retrospectively analyzed, including 30 patients with OB, and the clinical characteristics, treatment effects and survival of OB and non-OB patients were analyzed and compared.
OB occurred in 11.8% (22/187) of patients who received autologous stem cell transplantation(ASCT) and only 1.8% (8/437) of patients who did not receive ASCT (P=0.000). The median time to the appearance of oligoclonal bands was 3.2(0.6-10.5) months after transplantation. The M protein types of oligoclonal bands mainly include IgG κ, IgG λ, IgM λ and λ light chains. In the presence of oligoclonal bands, 90% of patients were evaluated as complete remission (CR) and above. There were no statistically significant differences in disease stage, tumor burden, and genetic abnormalities between OB and non-OB patients. Among the all patients, the prognosis of OB patients was significantly better than that of non-OB patients, and OB patients showed deeper disease remission (significantly higher CR rate, MRD negative rate, and longer MRD negative duration). Among patients who underwent ASCT, OB patients showed earlier immune recovery, but the depth of treatment response and survival outcomes were similar between OB and non-OB patients, it was no statistically difference. Although OB patients showed earlier immune reconstitution, this did not translate into better survival, suggesting that the better prognosis of OB patients was mainly related to deeper and durable remission rather than early immune reconstitution. Further analysis in patients who received ASCT and obtained MRD negative indicated that there was no additional survival benefit in patients with OB.
The better prognosis of OB patients may be related to the deeper treatment response, but not to the early immune reconstitution. The appearance of OB is only a sign of deep remission and early immune reconstitution in patients, it cannot be translated into survival benefit of MM patients.
探讨寡克隆区带（OB）在多发性骨髓瘤（MM）患者中的临床价值。
回顾性分析2013年1月至2019年12月在中国医学科学院血液病医院收治的624例新诊断MM患者的实验室检查及临床资料，其中有OB的患者30例，分析并比较OB患者与非OB患者的临床特征、治疗效果及生存情况。
接受自体干细胞移植（ASCT）的患者中11.8%（22/187）出现OB，未接受ASCT的患者中仅1.8%（8/437）出现OB（P = 0.000）。寡克隆区带出现的中位时间为移植后3.2（0.6 - 10.5）个月。寡克隆区带的M蛋白类型主要包括IgG κ、IgG λ、IgM λ和λ轻链。出现寡克隆区带时，90%的患者评估为完全缓解（CR）及以上。OB患者与非OB患者在疾病分期、肿瘤负荷及基因异常方面无统计学差异。在所有患者中，OB患者的预后明显优于非OB患者，且OB患者疾病缓解更深（CR率、微小残留病阴性率显著更高，微小残留病阴性持续时间更长）。在接受ASCT的患者中，OB患者免疫恢复更早，但OB患者与非OB患者的治疗反应深度及生存结局相似，无统计学差异。虽然OB患者免疫重建更早，但这并未转化为更好的生存，提示OB患者较好的预后主要与更深且持久的缓解有关，而非早期免疫重建。对接受ASCT并获得微小残留病阴性的患者进一步分析表明，OB患者无额外的生存获益。
OB患者较好的预后可能与更深的治疗反应有关，而非早期免疫重建。OB的出现仅是患者深度缓解和早期免疫重建的一个标志，不能转化为MM患者的生存获益。
