多发性骨髓瘤214例临床分析

目的探讨多发性骨髓瘤(MM)患者的临床特征及影响MM患者生存的预后因素,分析主要治疗方法的长期生存情况。方法回顾214例MM患者的临床特点、实验室检查及治疗方法。对9项临床和实验室指标进行单因素和多因素分析,对主要治疗方法(VAD样方案和BD方案)进行生存分析。结果 214例MM患者发病中位年龄为59.7岁,初诊时最常见的临床表现为骨痛(77.1%)、贫血(70%)、肾功能损害(24.8%)。单因素分析显示年龄、骨髓瘤细胞比例、血红蛋白、β2微球蛋白(β2-MG)、肌酐(Scr)、Ⅲ期为影响总生存期(OS)的预后因素;COX回归多因素分析显示年龄、骨髓瘤细胞比例、β2-MG为影响OS的独立不良预后因素。应用BD方案的中位生存期明显高于VAD样方案,分别为56个月和39个月,生存曲线比较,P=0.028。结论 MM临床表现复杂多样,极易误诊;高龄、高β2-MG、高骨髓瘤细胞比例的患者预后差;与传统VAD方案相比,应用新药硼替佐米的患者生存期明显延长。

The clinical and laboratory features of 214 patients with multiple myeloma

Objective To explore the clinical features and the influence of various prognostic factors on survival of patients with multiple myeloma （MM） and the survival rates of major therapeutic options were evaluated.Methods A retrospective analysis were performed on the clinical characteristics, laboratory examination and therapeutic options of 214 cases of MM patients. Nine clinical and laboratory parameters were analyzed by univariate and multivariate process. Survival analysis about major therapeutic options were performed.Results The median age of onset was 59.7 years. The most common clinical manifestations include bone pain （77.1%）, anemia （70%）, renal impairment （24.8%）. Univariate analysis suggested thatage, percentage of plasma cell in bone marrow, hemoglobin, β2-microglobulin （β2-MG）, Scr, stageⅢ were prognostic factors for overall survival （OS）. Multivariate analysis suggested that age, percentage of plasma cell in bone marrow, and β2-MG were all independent prognostic factors for OS. Compared with VAD-like regimen, the patients on a BD regimen showed a superior median OS, 56 months and 39 months, respectively, survival curve was significant （P=0.028）.Conclusion Clinical manifestations of MM are complicated and difficult to diagnosis. Age, highβ2-MG, high proportion of MM cells were highly related to poor prognosis of MM patients. Compared with traditional VAD regimen, application of new drug bortezomib in patients significantly extend the survival rates of patients.