CAJ | 학술논문

目的分析沙利度胺治疗初诊时伴或不伴髓外病变(EM)的多发性骨髓瘤(MM)患者的疗效及对预后的影响.方法回顾性分析132例MM患者的临床特点及其预后相关因素,分析沙利度胺对伴或不伴EM的MM患者的疗效及对预后的影响.结果 132例患者中位年龄59岁(28～83岁),其中52例(39.4％)伴EM；80例(60.6％)不伴EM.伴EM患者预计总生存(OS)时间为42.5个月,不伴EM患者为54.3个月,差异有统计学意义(P=0.004).所有患者中,服用沙利度胺的MM患者预计OS较未服用者长(50.7个月比41.2个月),差异有统计学意义(P=0.01)；对于EM患者,是否服用沙利度胺对患者预后差异无统计学意义(39.7个月比38.5个月,P=0.491),而对初诊时不伴EM的MM患者,服用沙利度胺的患者预后明显优于未服用者(54.6个月比41.2个月,P=0.027).单因素分析显示初诊时伴EM (P=0.004)、浆细胞比例≥20％(P=0.02)、血红蛋白≤110 g/ L(P=0.041)、β2微球蛋白(β2-MG) ≥5.5 mg/L(P=0.018)及未服用沙利度胺(P=0.01)为预后不良指标；COX多因素分析显示,EM、β2-MG以及浆细胞比例为本组患者的独立预后因素(P＜0.05).结论初诊时伴EM患者较不伴EM者预后差,沙利度胺不能改善伴EM患者的预后,可能需要联合硼替佐米等新药或进行自体造血干细胞移植.
목적 분석사리도알치료초진시반혹불반수외병변(EM)적다발성골수류(MM)환자적료효급대예후적영향.방법 회고성분석132례MM환자적림상특점급기예후상관인소,분석사리도알대반혹불반EM적MM환자적료효급대예후적영향.결과 132례환자중위년령59세(28～83세),기중52례(39.4％)반EM；80례(60.6％)불반EM.반EM환자예계총생존(OS)시간위42.5개월,불반EM환자위54.3개월,차이유통계학의의(P=0.004).소유환자중,복용사리도알적MM환자예계OS교미복용자장(50.7개월비41.2개월),차이유통계학의의(P=0.01)；대우EM환자,시부복용사리도알대환자예후차이무통계학의의(39.7개월비38.5개월,P=0.491),이대초진시불반EM적MM환자,복용사리도알적환자예후명현우우미복용자(54.6개월비41.2개월,P=0.027).단인소분석현시초진시반EM (P=0.004)、장세포비례≥20％(P=0.02)、혈홍단백≤110 g/ L(P=0.041)、β2미구단백(β2-MG) ≥5.5 mg/L(P=0.018)급미복용사리도알(P=0.01)위예후불량지표；COX다인소분석현시,EM、β2-MG이급장세포비례위본조환자적독립예후인소(P＜0.05).결론 초진시반EM환자교불반EM자예후차,사리도알불능개선반EM환자적예후,가능수요연합붕체좌미등신약혹진행자체조혈간세포이식.
Objective To investigate the clinical efficiency and effects on prognosis of thalidomide for newly diagnosed multiple myeloma (MM) with or without extramedullary disease.Methods The clinical features and prognostic factors were retrospectively analyzed in 132 patients.Analyze the efficiency of thalidomide and its effects on prognosis of MM patients with or without extramedullary disease.Results The median age of 132 patients was 59 years (28-83 years),52 patients (39.4 ％) had extramellulary multiple myeloma (EM),other 80 patients (60.6 ％) were without EM at diagnosis.The estimate overall survival (OS) of patients with EM was 42.5 months,compared with 54.3 months in those without EM,the difference was statistically significant (P =0.004).Patients accepting thalidomide therapy had a longer estimate OS than those without thalidomide therapy (50.7 months vs 41.2 months,P =0.01).For patients with EM,whether take thalidomide or not have no effect on the prognosis,the difference was not statistically significant (39.7 months vs 38.5 months,P =0.491).While for those without EM,the prognosis for patients who take thalidomide was better than that did not take thalidomide (54.6 months vs 41.2 months,P =0.027).Log-rank univariate analysis showed that accompanied with EM (P =0.004),the proportion of plasma cells≥20 ％ (P =0.02),Hb≤110 g/L (P =0.041),β2-MG ≥ 5.5 mg/L (P =0.018) and without thalidomide therapy (P =0.01) were poor prognostic factors.Multivariate analysis with COX model showed extramedullary disease,β2-MG and the proportion of plasma cells were statistically significant (P ＜ 0.05).Conclusion Patients with EM showed aggressive and complicated prognosis.Thalidomide does not improve the prognosis of patients with EM and they may need combination therapy such as bortezomib or autologous hemopoietic stem cell transplantation.