沙利度胺治疗132例初诊时伴或不伴髓外病变多发性骨髓瘤的疗效比较

摘要

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.%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.