天津医药

天津医药 ›› 2020, Vol. 48 ›› Issue (5): 415-420.doi: 10.11958/20193032

• 临床研究 • 上一篇    下一篇

初诊伴髓外病变的多发性骨髓瘤患者的临床特征及预后分析 #br#

付庆华，夏冰，杨洪亮，许雯，赵海丰，于泳，赵智刚，王亚非，王晓芳△   

  1. ：天津医科大学肿瘤医院血液科，国家肿瘤临床医学研究中心，天津市“肿瘤防治”重点实验室，天津市恶性肿瘤临床医学研究
    中心（邮编     300060）

  • 收稿日期:2019-10-14 修回日期:2020-03-04 出版日期:2020-05-15 发布日期:2020-06-24
  • 通讯作者: 王晓芳 E-mail:wangxiaofang2005@126.com
  • 作者简介:付庆华（1994），女，硕士在读，主要从事血液肿瘤方面研究

Clinical features and prognostic analysis of newly diagnosed multiple myeloma with extramedullary disease #br#

FU Qing-hua, XIA Bing, YANG Hong-liang, XU Wen, ZHAO Hai-feng, YU Yong, ZHAO Zhi-gang, WANG Ya-fei, WANG Xiao-fang△ #br#   

  1. Department of Hematology, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
  • Received:2019-10-14 Revised:2020-03-04 Published:2020-05-15 Online:2020-06-24

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摘要： 摘要：目的 分析初诊伴不同类型髓外病变（EMD）的多发性骨髓瘤（MM）患者临床特征及对预后的影响。方
法 回顾性分析本院收治资料完整的 99例初诊伴 EMD的 MM患者在性别、年龄、免疫球蛋白类型、DS分期、ISS分期
等临床特征上的异同，对不同髓外病变类型的患者进行生存及预后分析并探究不同治疗方案的预后意义。结果
伴骨旁髓外病变（bEMD，57例）与非骨旁髓外病变（sEMD，42例）的 MM患者之间临床特征差异无统计学意义（P＞
0.05）。2种最多见髓外病变部位分别为肋骨（42.1%）及软组织（50.0%）。bEMD组和 sEMD组中位总生存期（OS，45
个月 vs. 15 个月）、中位无进展生存期（PFS，20 个月 vs.10 个月）差异均有统计学意义（P＜0.05）。年龄≥60 岁（HR=
2.333，95%CI：1.025～5.309，P＜0.05）、β2-MG≥2.7 mg/L（HR=4.361，95%CI：1.304～14.587，P＜0.05）及 TP53 突变
（HR=3.697，95%CI：1.015～13.469，P＜0.05）为影响 EMD患者 OS的独立预后因素。sEMD组含硼替佐米诱导化疗后
序贯 ASCT的患者中位 PFS（49个月vs. 9个月，P＜0.05）和中位 OS（79个月vs. 12个月，P＜0.05）与化疗后未行自体造
血干细胞移植患者相比具有统计学意义。结论 伴 sEMD的 MM患者预后较 bEMD差，含硼替佐米化疗序贯自体造
血干细胞移植有可能会延长伴 sEMD患者生存，改善预后。

关键词: 多发性骨髓瘤, 硼酸化物, 造血干细胞移植, 预后, 髓外病变, 硼替佐米

Abstract: Abstract: Objective To analyze the clinical characteristics and prognosis of newly diagnosed multiple myeloma (MM)
patients with different types of extramedullary disease (EMD). Methods Data of gender, age, immunoglobulin type, DS
stage, ISS stage and other clinical characteristics of 99 MM patients with EMD who were admitted to our hospital and had
complete clinical data were retrospectively analyzed. The survival analysis and prognostic analysis on patients with different
types of extramedullary diseases were performed, and the prognostic significance of different therapeutic regimens was
explored. Results There were no significant differences in clinical characteristics between MM patients with the bonerelated EMD (bEMD, n=57) and strict EMD (sEMD, n=42, P＞0.05). The two types of extramedullary diseases were mainly
found in ribs (42.1%) and soft tissues (50.0%) respectively. There were significant differences in median OS time (45 months
vs. 15 months, P＜0.05) and median PFS (20 months vs. 10 months, P＜0.05) between bEMD group and sEMD group. It was
found that age≥60 years (HR=2.333, 95%CI:1.025-5.309, P＜0.05),β2-MG≥2.7 mg/L (HR=4.361, 95%CI:1.304-14.587,
P＜0.05) and mutation of TP53 (HR=3.697, 95%CI:1.015-13.469,P＜0.05) were independent prognostic factors affecting
OS in EMD patients. The median PFS (49 months vs. 9 months, P＜0.05) and median OS (79 months vs. 12 months, P＜0.05)
of patients with sequential ASCT after bortezomi-induced chemotherapy in the sEMD group were statistically significant
compared with those without ASCT. Conclusion The prognosis of MM patients with sEMD is worse than that of bEMD
patients. The sequential autologous hematopoietic stem cell transplantation with bortezomib chemotherapy may prolong the survival and improve prognosis of patients with sEMD.

Key words: multiple myeloma, boronic acids, hematopoietic stem cell transplantation, prognosis, extramedullary
disease, bortezomib

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