摘要
目的:提高对骨髓单克隆浆细胞比例小于10%的新诊断多发性骨髓瘤(NDMM)患者的认识。方法:回顾性总结2009年1月至2017年12月北京协和医院36例骨髓浆细胞比例小于10%的NDMM患者的临床特点、实验室检查、治疗反应和预后情况,选择同期诊断的72例骨髓浆细胞比例≥10%的NDMM患者作为对照组,两组患者年龄和性别匹配。结果:①在818例NDMM患者中,骨髓浆细胞比例小于10%的患者36例(4.4%),其中国际分期系统(ISS)Ⅲ期11例(30.6%),显著低于对照组患者[45例(62.5%)](P=0.002)。与对照组相比,骨髓浆细胞比例小于10%的患者合并髓外病变比例更高(33.3%对5.6%,P<0.001),血清M蛋白中位值更低[1.04(0~50.10)g/L对4.50(0~63.10)g/L,P=0.016],24 h尿轻链定量中位值更低(510 mg对2800 mg,P=0.023)。②骨髓浆细胞比例小于10%患者与对照组患者一线治疗后中位无进展生存(PFS)时间分别为26.4个月和19.9个月(HR=1.703,95%CI 0.167~0.233,P=0.002),总生存(OS)时间分别为65.8个月和46.2个月(HR=2.626,95%CI 0.439~0.541,P=0.058)。③按照M蛋白水平将研究组分为低肿瘤负荷组和高肿瘤负荷组,中位OS时间分别为66.4个月和24.0个月(HR=2.349,95%CI 0.603~0.696,P=0.046),中位PFS时间分别为33.1个月和15.5个月(HR=1.806,95%CI 0.121~0.399,P=0.077)。硼替佐米治疗对患者的生存结局无影响。结论:骨髓浆细胞比例小于10%的NDMM患者疾病分期较早,肿瘤负荷较低,尽管合并髓外病变比例更高,一线疗效以及总体预后优于骨髓浆细胞比例≥10%的患者。
Objective To improve the understanding of newly diagnosed multiple myeloma(NDMM)patients with bone marrow(BM)monoclonal plasma cell ratio of less than 10%.Methods The clinical characteristics,laboratory examination,response to treatment,and prognosis of 36 NDMM patients with BM plasma cell ratio of less than 10%at Peking Union Medical College Hospital from January 2009 to December 2017 were summarized retrospectively.In the same period,other age-and gender-matched 72 NDMM patients were selected as the control group,whose BM plasma cell ratio was equal to or greater than 10%.Results First,the patients in the study group accounted for 4.4%of the whole MM population(36/818),among which only 11(30.6%)were classified as International Staging System(ISS)Ⅲ,which was significantly lower than that in the control group[45(62.5%)](P=0.002).Extramedullary disease(EMD)was more common in the study group(33.3%vs 5.6%,P<0.001).The median quantity of serum M protein(g/L)in the less than 10%group was 1.04(0-50.10),which was significantly lower than that in the control group[4.50(0-63.10)](P=0.016),similar to the median quantity of 24-h urinary light chain(510 mg vs 2800 mg,respectively,P=0.023).Second,the median progression-free survival(PFS)times of front-line regimen in the study and control groups were 26.4 and 19.9 months,respectively(HR=1.703,95%CI 0.167-0.233,P=0.002).In addition,the overall survival(OS)times were 65.8 and 46.2 months,respectively(HR=2.626,95%CI 0.439-0.541,P=0.058).Third,the study group was reclassified based on the quantity of M protein.The median OS times in patients with low/high tumor load were 66.4 and 24.0 months,respectively(HR=2.349,95%CI 0.603-0.696,P=0.046).The median PFS times were 33.1 and 15.5 months,respectively(HR=1.806,95%CI 0.121-0.399,P=0.077).Bortezomib-based regimens did not affect the clinical outcomes.Conclusion The subpopulation of patients with MM with BM monoclonal plasma cell ratio less than 10%has specific clinical characteristics,including an early disease stage and a lower ove
作者
赵静婷
蒋显勇
杨辰
陈苗
蓝夏璐
杜建华
周道斌
庄俊玲
Zhao Jingting;Jiang Xianyong;Yang Chen;Chen Miao;Lan Xialu;Du Jianhua;Zhou Daobin;Zhuang Junling(Peking Union Medical College,Chinese Academy of Medical Sciences&Department of Hematology,Peking Union Medical College Hospital,Beijing 100730,China)
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2021年第4期295-301,共7页
Chinese Journal of Hematology
基金
北京市自然科学基金(7192175)
中国医学科学院医学与健康科技创新工程项目(2016-I2M-3-025)。
关键词
多发性骨髓瘤
骨髓单克隆浆细胞
肿瘤负荷
预后
Multiple myeloma
Bone marrow monoclonal plasma cell
Tumor load
Prognosis
