CAJ | 학술논문

目的探讨1q21扩增在新诊断的多发性骨髓瘤(MM)患者中对治疗效果的影响和预后价值.方法收集2008年6月至2010年6月收治的52例初治MM患者,利用荧光原位杂交(FISH)技术对其进行1q21扩增的检测,并分析其与患者临床特征、疗效及预后的关系.结果在52例初治MM患者中,30例(57.7％)伴有1q21扩增,其临床特征(性别、恶性胸腔积液、髓外浆细胞瘤、骨质破坏、β 2-微球蛋白、清蛋白、血红蛋白、血钙、浆细胞数、分型及临床分期等)与不伴有1q21扩增的患者比较,差异均无统计学意义(均P＞ 0.05).52例患者被分为1q21扩增组(30例)和1q21未扩增组(22例),分别接受4个疗程硼替佐米联合地塞米松方案化疗,两组治疗总有效率差异无统计学意义[80.0％(24/30)比81.8％(18/22),P＞ 0.05].扩增组与未扩增组中位总生存期分别为26个月(6～50个月)和30个月(12～ 85个月),差异无统计学意义(P=0.409);两组中位无进展生存期分别为8个月(1～31个月)和20个月(3～ 48个月),差异有统计学意义(P=0.019).多因素分析结果显示,纳入因素中仅含1q21扩增同时伴有2个以上的复杂染色体核型是疗效的独立影响因素(P=0.031).结论 1q21扩增是影响MM患者的一个不良预后因素,1q21扩增阳性的患者接受硼替佐米的治疗效果与阴性的患者无明显差异.但1q21扩增阳性患者的中位PFS较阴性患者明显缩短,复发较快.
목적 탐토1q21확증재신진단적다발성골수류(MM)환자중대치료효과적영향화예후개치.방법 수집2008년6월지2010년6월수치적52례초치MM환자,이용형광원위잡교(FISH)기술대기진행1q21확증적검측,병분석기여환자림상특정、료효급예후적관계.결과 재52례초치MM환자중,30례(57.7％)반유1q21확증,기림상특정(성별、악성흉강적액、수외장세포류、골질파배、β 2-미구단백、청단백、혈홍단백、혈개、장세포수、분형급림상분기등)여불반유1q21확증적환자비교,차이균무통계학의의(균P＞ 0.05).52례환자피분위1q21확증조(30례)화1q21미확증조(22례),분별접수4개료정붕체좌미연합지새미송방안화료,량조치료총유효솔차이무통계학의의[80.0％(24/30)비81.8％(18/22),P＞ 0.05].확증조여미확증조중위총생존기분별위26개월(6～50개월)화30개월(12～ 85개월),차이무통계학의의(P=0.409);량조중위무진전생존기분별위8개월(1～31개월)화20개월(3～ 48개월),차이유통계학의의(P=0.019).다인소분석결과현시,납입인소중부함1q21확증동시반유2개이상적복잡염색체핵형시료효적독립영향인소(P=0.031).결론 1q21확증시영향MM환자적일개불량예후인소,1q21확증양성적환자접수붕체좌미적치료효과여음성적환자무명현차이.단1q21확증양성환자적중위PFS교음성환자명현축단,복발교쾌.
Objective To investigate the value of 1q21 amplification in newly diagnosed myeloma patients.Methods Fifty-two cases of newly diagnosed multiple myeloma from June 2008 to June 2010 were enrolled.Fluorescence in situ hybridization (FISH) was used to detect the 1q21 amplification,and the clinical characteristics and treatment response were analyzed.Results 1q21 amplification was discovered in 30 of 52 patients (57.7 ％),Clinical characteristics such as gender,malignant pleural effusion,extramedullary plasmacytoma,bone destruction,β2 microglobulin,ALB,hemoglobin,blood calcium,plasma cell proportion,clinical stage seemed to have no correlation with 1q21 amplification.The 52 patients all received bortezomibbased regimens.The response rates were not significant difference between patients with and without 1q21 amplification,the OS was also not significant difference [26 months (6-30 months) vs 30 months (12-85 months),P =0.409],but the patients with presence of 1q21 gain resulted in significantly shorter PFS [8 months (1-30 months) vs 20 months (3--48 months),P=0.019].Multivariate analysis showed 1q21 with more than two additional genetic abnormalities was an independent prognostic predictor (P =0.031).Conclusion 1q21 amplification is one of the adverse prognostic predictors,the response rate is not significant difference between patients with and without 1q21 amplification in bortezomib-based group,but the 1q21 amplification could result in significantly shortened PFS.