摘要
目的探讨初诊多发性骨髓瘤(NDMM)患者中ISS-Ⅲ期伴高危细胞遗传学异常(HRCA)1q获得/扩增或17p缺失双重打击的预后意义。方法回顾性分析2009年11月至2018年5月就诊的270例NDMM患者的临床资料,将ISS-Ⅲ期和两种HRCA(1q获得/扩增和17p缺失)定义为打击因素,根据患者携带打击因素的数目分组,应用Kaplan-Meier曲线分析各组无进展生存(PFS)和总生存(OS)时间的差异。结果无打击因素组患者66例(24.4%),中位PFS和OS时间分别为28.9和53.7个月;一种打击因素组120例(44.4%),中位PFS和OS时间分别为23.0个月和42.3个月(P值均>0.05),后者预后较差;与一种打击因素组比较,携带两种及以上打击因素组患者84例(31.1%),中位PFS和OS时间均显著缩短,分别为14.5个月(HR=1.584,95%CI 1.082~2.319;P=0.003)和18.4个月(HR=2.299,95%CI 1.485~3.560;P<0.001);其中5例(1.9%)携带三种打击因素,其PFS时间为0.9~15.1个月,OS时间为0.9~18.9个月,均较携带两种打击因素组显著缩短,预后最差。进一步分析ISS分期与HRCA的不同组合,结果类似。结论基于ISS分期与细胞遗传学异常的FISH检测,携带两种或以上危险因素(包括ISS-Ⅲ期和HRCA)的双/多重打击NDMM患者预后极差。
Objective To evaluate the prognostic significance of combining ISS-Ⅲ and high risk cytogenetic abnormalities[HRCAs,including 1q gain/amplification and del(17p)]in patients with newly-diagnosed multiple myeloma(NDMM).Methods The clinical characteristics and relevant variables were retrospectively analyzed in a total of 270 NDMM patients diagnosed between November 2009 and May 2018.ISS-Ⅲ stage and HRCAs[detected by FISH,including 1q gain/amplification and del(17p)]were defined as risk factors(hit).Based to the number of hit per case,these patients were divided into four groups carrying 0 to 3 risk factors,respectively.Progress-free survival(PFS)and overall survival(OS)were then analyzed using the Kaplan-Meier estimator.Results Patients who carried single hit(n=120,44.4%)had shorter median PFS(23.0 vs 28.9 months;P>0.05)and OS(42.3 vs 53.7 months;P>0.05)than those with no risk factors(n=66,24.4%).Of note,the outcome of patients who had two or more risk factors(double/triple,n=84,31.1%)was much worse than those with either no or one risk factor,indicated by significantly reduced median PFS(14.5 months;HR=1.584,95%CI 1.082-2.319;P=0.003 for double/triple vs single hit)and OS(18.4 months,HR=2.299,95%CI 1.485-3.560;P<0.001 for double/triple vs single hit).Strikingly,patients who had three risk factor(triple hit,n=5,1.9%)displayed the poorest survival with extraordinarily shorter PFS(0.9-15.1 months)and OS(0.9-18.9 months)compared to those carrying two risk factors(double hit).Analogous results were obtained when different combinations of ISS stages and HRCAs were analyzed.Conclusion These results suggest a potential but rather important role of combining multiple(e.g.double or triple)adverse factors determined via the routine ISS staging and FISH detection of cytogenetic abnormalities in risk stratification and prognostic prediction,which might be helpful to identify high risk patients more precisely at diagnosis.It also raised a possibility that a small group of ISS-Ⅲpatients carrying both 1q gain/amplification and del(17p)might represent an"extremely-high risk"subset of MM.
作者
刘雪莲
杨艳萍
白晶
岳婷婷
杨珮钰
张烨
樊红琼
李薇
靳凤艳
Liu Xuelian;Yang Yanping;Bai Jing;Yue Tingting;Yang Peiyu;Zhang Ye;Fan Hongqiong;Li Wei;Jin Fengyan(Department of Hematology,Cancer Center,the First Affiliated Hospital of Jilin University,Changchun 130021,China)
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2019年第11期912-917,共6页
Chinese Journal of Hematology
基金
国家自然科学基金(81670190、81670189、81870160)。
