摘要
目的观察GPRC5D在新诊断多发性骨髓瘤(NDMM)患者骨髓瘤细胞上的表达情况并探讨其预后价值。方法回顾性分析2023年4月至2024年4月在徐州医科大学附属医院就诊的65例NDMM患者的临床资料。所有患者在诱导治疗前均应用流式细胞术检测骨髓瘤细胞表面GPRC5D的表达情况,根据GPRC5D阳性率中位数将患者分为GPRC5D高表达组和低表达组,比较两组患者的临床特征、免疫状态、诱导治疗后疗效及预后。结果65例NDMM患者浆细胞GPRC5D阳性率的中位数为32.68%,以此为界值将患者分为GPRC5D高表达组(33例,GPRC5D阳性率≥32.68%)和GPRC5D低表达组(32例,GPRC5D阳性率<32.68%)。与GPRC5D低表达组相比,GPRC5D高表达组1q21扩增比例较高(78.8%对43.8%,P=0.004),出现≥2种未受累免疫球蛋白免疫麻痹比例(87.9%对62.5%,P=0.018)和重度免疫麻痹比例(59.4%对33.3%,P=0.046)较高,CD16+CD56+细胞比例较低[(16.60±8.70)%对(27.78±15.78)%,P=0.005]。GPRC5D高表达和低表达组诱导治疗的总体反应率差异无统计学意义(78.8%对93.8%,P=0.165),但GPRC5D高表达组疗效达到非常好的部分缓解及以上的比例更低(42.4%对78.2%,P=0.003),且微小残留病阴性率也较低(30.0%对68.8%,P=0.002)。与GPRC5D低表达组相比,GPRC5D高表达组患者具有更短的中位无进展生存期(11.2个月对未达到,P=0.002),两组患者的中位总生存期均未达到,差异无统计学意义(P=0.069)。结论NDMM患者浆细胞GPRC5D阳性率与1q21扩增及免疫状态有关。初诊时GPRC5D高表达可能预示患者对诱导治疗疗效不佳、预后不良。
ObjectiveTo investigate GPRC5D expression on myeloma cells in newly diagnosed multiple myeloma(NDMM)patients and evaluate its prognostic significance.MethodsThis study retrospectively analyzed the clinical data of 65 patients with NDMM treated at the Affiliated Hospital of Xuzhou Medical University from April 2023 to April 2024.The expression of GPRC5D on the surface of myeloma cells in all patients was detected with flow cytometry before induction therapy,and patients were stratified into high and low GPRC5D expression groups based on the median GPRC5D positivity rate.Clinical characteristics,immune status,treatment response after induction therapy,and prognosis were compared between the two groups.ResultsThe median positive rate of GPRC5D in the plasma cells of 65 patients with NDMM was 32.68%.Based on this threshold,patients were categorized into the high(33 cases,GPRC5D positive rate≥32.68%)and low(32 cases,GPRC5D positive rate<32.68%)GPRC5D expression groups.Compared with the low GPRC5D expression group,the high GPRC5D expression group demonstrated a higher proportion of 1q21 gain(78.8%vs 43.8%,P=0.004),a higher incidence of immunoparesis involving≥2 uninvolved immunoglobulins(87.9%vs 62.5%,P=0.018),and severe immunoparesis(59.4%vs 33.3%,P=0.046).Further,CD16+CD56+cell levels were lower in the high GPRC5D expression group[(16.60±8.70)%vs(27.78±15.78)%,P=0.005].No significant difference was observed in the overall response rate between the high and low GPRC5D expression groups(78.8%vs 93.8%,P=0.165).However,the high GPRC5D expression group exhibited a significantly lower rate of achieving very good partial remission or better(42.4%vs 78.2%,P=0.003)and a lower MRD negativity rate(30.0%vs 68.8%,P=0.002).Compared with the low GPRC5D expression group,patients with high expression demonstrated a significantly shorter median progression-free survival(11.2 months vs not reached,P=0.002),whereas the median overall survival was not reached in either group,with no statistically significant difference(P=0.069).ConclusionsThe GPRC5D positivity rate in the plasma cells of patients with NDMM is associated with 1q21 gain and immune status.High GPRC5D expression at diagnosis may predict poor response to induction therapy and an unfavorable prognosis.
作者
金琮倩
颜芬
马嫒
徐开林
夏洁云
Jin Congqian;Yan Fen;Ma Ai;Xu Kailin;Xia Jieyun(Department of Hematology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China)
出处
《中华血液学杂志》
北大核心
2025年第4期321-327,共7页
Chinese Journal of Hematology
基金
国家自然科学基金(82341203)。
