初诊时伴髓外病变的多发性骨髓瘤患者预后及影响因素分析

目的 探讨初诊伴髓外病变（EMD）的多发性骨髓瘤（MM）患者的临床特征及预后影响因素。方法 回顾性分析51例初诊伴EMD的MM患者的临床病理特征、EMD发生的部位、疗效、生存及影响预后的因素。结果 51例患者中位随访44个月（范围7～98个月）。与骨外EMD组相比，骨旁EMD组溶骨性病变≥3处比例较高（P=0.033）、淋巴细胞绝对值较高（P=0.016）、单核细胞与淋巴细胞比值较低（P=0.036）。初诊合并骨旁EMD组的预计中位总生存（overall survival, OS）未达到、初诊合并骨外EMD的预计中位OS为38个月（P=0.056）。多因素分析显示，对于初诊合并EMD的MM患者，血红蛋白＜118.8 g/L（OR=0.139, 95%CI=0.040~0.488, P=0.002）为OS的独立不良预后因素。结论 初诊MM患者合并EMD预后差，其中合并骨旁EMD的患者预后优于合并骨外EMD的患者。初诊时低血红蛋白是预后不良的独立影响因素。

Clinical features and prognosis in patients with multiple myeloma who had extramedullary disease at diagnosis

Objective To investigate the clinical features and prognosis of patients with multiple myeloma (MM) who had extramedullary disease (EMD) at diagnosis. Methods A total of 51 newly diagnozed MM patients who had EMD at diagnosis (including skeletal EMD and extraskeletal EMD) were retrospectively analyzed. The clinical features, EMD location, efficacy, survival and prognosis were explored. Results The median follow up was 44 months (ranged from 7 to 98 months). Patients in skeletal EMD group had significantly higher percentage of osteolytic lesions ≥3(P=0.033), higher lymphocyte cells (P=0.016), and lower monocyte to lymphocyte ratio (P=0.036) than that extraskeletal EMD group. The estimated overall survival(OS) of patients in extraskeletal EMD group was shorter than those in skeletal EMD group (38 months vs not reached, P=0.056). Multivariate analysis showed that hemoglobin (HGB)＜118.8 g/L (OR=0.139, 95%CI=0.040 0.488, P=0.002) was independently associated with inferior OS for the MM patients who had EMD at diagnosis. Conclusion The prognosis in patients with MM who had EMD at diagnosis is poor. The patients in skeletal EMD group have better prognosis than those in extraskeletal EMD group. Lower HGB is an independent factor for predicting inferior OS.