Suzuki Kazuhito, Gunji Tadahiro, Kawashima Masaharu, Uryu Hideki, Nagao Riku, Saito Takeshi, Nishiwaki Kaichi, Yano Shingo
Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Tokyo, Japan.
Cancer Diagn Progn. 2024 Nov 3;4(6):696-705. doi: 10.21873/cdp.10384. eCollection 2024 Nov-Dec.
BACKGROUND/AIM: Background/Aim: Thrombocytopenia is a poor prognostic factor in patients with myeloma; however, the factors associated with thrombocytopenia have not been extensively discussed. This study aimed to investigate the clinical significance of thrombocytopenia, defined as 130×10/μl or less, in patients with newly diagnosed multiple myeloma (NDMM) treated with proteasome inhibitors and/or immunomodulatory drugs.
This is a retrospective review of medical records of myeloma patients treated between 2000 and 2021. A total of 241 patients were included in this study, with a median age of 72 years. Overall survival (OS) and time to next treatment (TTNT) were assessed using Kaplan-Meier analysis and Cox regression analysis. Prognostic factors were evaluated by univariate and multivariate analyses.
The incidence of thrombocytopenia was 17.8%. In the median follow-up period of 46.6 months, OS and TTNT in the thrombocytopenia group were significantly shorter than those in the non-thrombocytopenia group using multivariate analysis (p<0.001 and p<0.001). C-reactive protein (CRP) level was not associated with thrombocytopenia, and high CRP predicted short OS and TTNT independently from thrombocytopenia. When the low (neither thrombocytopenia nor high CRP), intermediate (either thrombocytopenia or high CRP), and high (thrombocytopenia and high CRP) risk groups were defined, the OS and TTNT among these groups showed significant differences; the hazard ratios for survival in the high and intermediate risk groups were 7.022 and 2.598, and for TTNT, they were 4.216 and 1.887, respectively, compared to the low-risk group.
Thrombocytopenia was associated with the activity of NDMM and predicted prognosis in NDMM. When combined with high CRP levels, thrombocytopenia serves as a new indicator of poor prognosis in these patients.
背景/目的：血小板减少症是骨髓瘤患者预后不良的因素；然而，与血小板减少症相关的因素尚未得到广泛讨论。本研究旨在探讨血小板减少症（定义为130×10⁹/μl或更低）在接受蛋白酶体抑制剂和/或免疫调节药物治疗的新诊断多发性骨髓瘤（NDMM）患者中的临床意义。
这是一项对2000年至2021年期间接受治疗的骨髓瘤患者病历的回顾性研究。本研究共纳入241例患者，中位年龄为72岁。采用Kaplan-Meier分析和Cox回归分析评估总生存期（OS）和下次治疗时间（TTNT）。通过单因素和多因素分析评估预后因素。
血小板减少症的发生率为17.8%。在中位随访期46.6个月时，多因素分析显示血小板减少症组的OS和TTNT显著短于非血小板减少症组（p<0.001和p<0.001）。C反应蛋白（CRP）水平与血小板减少症无关，高CRP独立于血小板减少症预测OS和TTNT较短。当定义低（既无血小板减少症也无高CRP）、中（有血小板减少症或高CRP）和高（血小板减少症且高CRP）风险组时，这些组之间的OS和TTNT显示出显著差异；与低风险组相比，高风险组和中风险组生存的风险比分别为7.022和2.598，TTNT的风险比分别为4.216和1.887。
血小板减少症与NDMM的活动相关，并可预测NDMM的预后。当与高CRP水平相结合时，血小板减少症是这些患者预后不良的新指标。
