多发性骨髓瘤临床、实验室及组织学特征的预后价值：风险组定义的改进

Prognostic value of clinical, laboratory, and histological characteristics in multiple myeloma: improved definition of risk groups.

作者信息

Peest D, Coldewey R, Deicher H, Sailer M, Vykoupil C, Leo R, Georgii A, Karow J, Hoeppner E, Diehl V

机构信息

Abt. Immunologie und Transfusionsmedizin, Zentrum Innere Medizin und Dermatologie, Medizinische Hochschule Hannover, F.R.G.

出版信息

Eur J Cancer. 1993;29A(7):978-83. doi: 10.1016/s0959-8049(05)80205-9.

DOI:10.1016/s0959-8049(05)80205-9

PMID:8499152

Abstract

Follow-up data of 320 multiple myeloma (MM) patients entering the German Myeloma Treatment Group (GMTG) trial MM01 were analysed for factors predicting overall (OAS) and tumour related survival (TRS). Response to primary induction chemotherapy was relevant for prognosis if a limit of 25% tumour cell mass (TCM) reduction was used to separate responders from non-responders. Furthermore, TCM, histological grading of myeloma cells, degree of bone marrow infiltration, haemoglobin, platelet counts, calcium, creatinine, albumin, beta 2M, and Bence Jones proteinuria correlated to both OAS and TRS. Age was relevant for OAS only. The multivariate analysis revealed histological grading, TCM and platelets as the most reliable prognostic factors. Based on these data the Durie/Salmon classification could be improved by defining poor prognosis patients (50% TRS: 16 months) characterised by pretreatment platelets of < or = 150,000 and/or poorly differentiated myeloma cell morphology. Patients lacking both risk factors displayed 50% survival times of 46 months in stage III and 88 months in stage II.

摘要

对进入德国骨髓瘤治疗组（GMTG）MM01试验的320例多发性骨髓瘤（MM）患者的随访数据进行分析，以寻找预测总生存期（OAS）和肿瘤相关生存期（TRS）的因素。如果以肿瘤细胞团块（TCM）减少25%为界限区分反应者和无反应者，则对初始诱导化疗的反应与预后相关。此外，TCM、骨髓瘤细胞的组织学分级、骨髓浸润程度、血红蛋白、血小板计数、钙、肌酐、白蛋白、β2M和本周蛋白尿均与OAS和TRS相关。年龄仅与OAS相关。多因素分析显示，组织学分级、TCM和血小板是最可靠的预后因素。基于这些数据，通过定义预后不良患者（50%TRS：16个月），Durie/Salmon分类可以得到改进，这些患者的特征为预处理时血小板≤150,000和/或骨髓瘤细胞形态分化差。缺乏这两个危险因素的患者在III期的50%生存期为46个月，在II期为88个月。