[新型药物时代新诊断多发性骨髓瘤患者早期复发的预后价值及危险因素分析]
[Analysis of the Prognostic Value and Risk Factors of Early Relapse for Newly Diagnosed Multiple Myeloma Patients in the Era of Novel Agents].
作者信息
Li Qi-Hui, Liu Yan, Wang Jing, Wang Ji-Jun, Dong Fei, Yang Ping, Wan Wei, Ke Xiao-Yan, Jing Hong-Mei
机构信息
Department of Hematology, The Third Hospital of Peking University, Beijing 100191, China.
Department of Hematology, The Third Hospital of Peking University, Beijing 100191, China,E-mail:
出版信息
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2023 Feb;31(1):148-153. doi: 10.19746/j.cnki.issn.1009-2137.2023.01.024.
OBJECTIVE
To investigate the influece of early relapse in the era of novel drugs on the prognosis of the patients with newly diagnosed multiple myeloma（NDMM） and risk factors, and to provide the basis for the early identification of the high-risk patients and guiding the treatment.
METHODS
The clinical data of the patients with NDMM admitted to our hospital from November 2011 to May 2022 were retrospectively analyzed. According to whether the progression free survival（PFS） was more than 12 months, they were divided into early relapse group（≤12 months） and late relapse group（＞12 months）. The high-risk factors of the patients in two groups were analyzed, including age, anemia, renal insufficiency, hypercalcemia, increasing of lactate dehydrogenase（LDH） level, Extramedullary disease (EMD), International Staging System（ISS） stage, Revised International Staging System （R-ISS） stage, cytogenetic abnormalities(CA) detected by fluorescence in situ hybridization（FISH）, and treatment efficacy. The meaningful clinical indicators were screened, and multivariate analysis was used to explore the high-risk factors of early relapse.
RESULTS
170 patients with NDMM were collected, including 25 cases in early relapse group and 145 cases in late relapse group. The median OS time of the patients in early death group was 20 months, and 140 months in late relapse group by the end of follow-up, there was significant difference in OS of the patients between two groups（<0.001）. Fifteen patients（56.0％）in early relapse group obtained ≥VGPR, and 113（77.9%） patients in late relapse group, the difference was statistically significant（=0.011）. Survival outcomes remained poor among early relapse patients irrespective of depth of response to initial therapy. Multivariate analysis showed that the EMD and high-risk CA predicted early relapse.
CONCLUSION
The prognosis of patients with early relapse in NDMM is poor. EMD and high-risk CA is an independent prognostic factor of early relapse.
目的
探讨新药时代早期复发对新诊断多发性骨髓瘤（NDMM）患者预后的影响及危险因素，为早期识别高危患者和指导治疗提供依据。
方法
回顾性分析2011年11月至2022年5月我院收治的NDMM患者的临床资料。根据无进展生存期（PFS）是否超过12个月，将其分为早期复发组（≤12个月）和晚期复发组（＞12个月）。分析两组患者的高危因素，包括年龄、贫血、肾功能不全、高钙血症、乳酸脱氢酶（LDH）水平升高、髓外病变（EMD）、国际分期系统（ISS）分期、修订国际分期系统（R-ISS）分期、荧光原位杂交（FISH）检测的细胞遗传学异常（CA）及治疗疗效。筛选有意义的临床指标，采用多因素分析探讨早期复发的高危因素。
结果
共收集170例NDMM患者，其中早期复发组25例，晚期复发组145例。至随访结束时，早期复发组患者的中位总生存期（OS）为20个月，晚期复发组为140个月，两组患者的OS有显著差异（<0.001）。早期复发组15例（56.0％）患者获得≥非常好的部分缓解（VGPR），晚期复发组113例（77.9%）患者获得该疗效，差异有统计学意义（=0.011）。无论初始治疗反应深度如何，早期复发患者的生存结局均较差。多因素分析显示，EMD和高危CA可预测早期复发。
结论
NDMM早期复发患者预后较差。EMD和高危CA是早期复发的独立预后因素。
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