mSMART3.0不同危险分层多发性骨髓瘤患者临床疗效与预后分析

目的比较mSMART 3.0分期高危与标危多发性骨髓瘤(MM)患者的临床疗效和预后。方法回顾性分析2014年1月至2019年4月福建省立医院77例初治MM患者的临床资料,采用间期荧光原位杂交(FISH)法检测染色体核型,比较高危与标危MM患者临床特征和疗效差异,Kaplan-Meier法比较两组生存曲线的差异,多因素Cox回归分析影响MM患者预后的危险因素。结果①高危组45例患者中位无进展生存(PFS)时间17.0个月,2年预期PFS率(31.0±8.7)%,标危组中位PFS时间未达到,2年预期PFS率(55.4±11.1)%,差异均有统计学意义(中位PFS:P=0.018;2年PFS率:P=0.035)。②17例"双打击"型患者中位PFS时间8.0个月,显著低于"非双打击"组的18.0个月(P=0.033)。③Cox回归分析显示细胞遗传学危险分层(HR=4.2,95%CI:1.6~11.3,P=0.004)是影响MM患者PFS的独立危险因素。④硼替佐米(BTZ)治疗显著延长伴t(4,14)和1q21扩增MM患者中位总生存(OS)时间,但对p53缺失/突变患者中位OS时间无显著影响。结论细胞遗传学危险分层是影响MM患者预后的独立危险因素,mSMART 3.0分期高危较标危患者2年疾病复发和(或)进展的风险明显增加。

Analysis of clinical effects and outcome of multiple myeloma patients with different risk stratification of mSMART 3.0

Objective To compare the clinical effect and prognosis of patients with high-risk and standard-risk multiple myeloma(MM)using mSMART 3.0. Methods The clinical data of 77 patients with newly diagnosed MM in the Department of Hematology,Fujian Provincial Hospital,from January 2014 to April 2019,were retrospectively analyzed. The clinical characteristics of high-risk and standard-risk patients were observed. The Kaplan–Meier curve was used to analyze the prognosis in the two groups. Multiple Cox regression was used to analyze the risk factors affecting the prognosis of patients with MM. Results(1)In 45 patients with high-risk cytogenetic abnormalities,the median progression-free survival(PFS)time was 17.0 months. The 2-year estimated PFS was(31.0 ± 8.7)%. In 32 patients with standard-risk cytogenetic abnormalities,the median PFS time was not reached. The 2-year estimated PFS was(55.4 ± 11.1)%. The PFS in the standard-risk group was significantly shorter than that in the high-risk group.(2)In the high-risk group,17 patients were in the double-hit group and 28 in the non-double-hit group. The median PFS was 8.0 months and 18.0 months,respectively.(3)The cytogenetic risk stratification was an independent prognostic factor for PFS.(4)Bortezomib significantly improved the prognosis of patients with 1q21 amplification and t(4,14);however,no improvement was observed for patients with del(17 p)/p53 mutation. Conclusions Cytogenetic risk stratification is an independent adverse prognostic factor for newly diagnosed MM. The high-risk group had a 3.2-times higher risk of recurrence and/or progression within 2 years compared with the standard-risk group in the Mayo mSMART 3.0 staging system.