Objective: To study the effects of clinicopathological features, laboratory parameters and treatment regimens on the prognosis of patients with multiple myeloma.
Methods: The clinical data of 97 patients with multiple myeloma treated with chemotherapy in Department of Hematology, the 1st Hospital of Hainan Medical College were analyzed retrospectively. The clinicopathological features (age, sex, severe anemia, light chain type, hypoproteinemia, paraplegia, renal injury, amyloidosis, complex karyotype, bone disease classification, Eastern Cooperative Oncology Group (ECOG) physical status score, complete remission, etc.), laboratory parameters (C-reactive protein, lactate dehydrogenase, blood calcium, serum β2 microglobulin, etc.), and treatment schemes (thalidomide maintenance treatment) were recorded. The patients were followed up for 1-60 months, and their total survival time were recorded. A single factor and multiple factors were used to analyze the factors affecting the total and early mortality of the patients. The survival curves were plotted by the Kaplan-Meier method and the survival analysis was carried out by Log-rank test.
Results: Among 97 patients, 29 cases (29.90%) achieved complete remission, and 56 cases (57.73%) achineved partial remission. The total effective rate was 87.63% (85/97). At the end of the follow-up, 19 cases (19.59%) died, and 1, 3 and 5 year survival rates were 80.41%, 71.13% and 37.11% respectively. The median overall survival time was 29 (1-60) months. The results of single factor analysis showed that age, hypoproteinemia, severe anemia, paraplegia, renal injury, amyloidosis, complex karyotype, complete remission and thalidomide maintenance therapy were the factors affecting the prognosis of the patients (all P＜0.05). Further multiple factor Logistic regression analysis showed that age and hypoproteinemia, severe anemia, paraplegia, amyloidosis, complex karyotype and thalidomide maintenance treatment were factors affecting the prognosis (P＜0.05). Of the 97 patients, 8 cases died early. The results of single factor analysis showed that amyloidosis and severe anemia were risk factors for early death (all P＜0.05), and further multivariate Logistic regression analysis showed that amyloidosis was an independent risk factor for early death (P＜0.05).
Conclusion: There are many adverse factors affecting the prognosis of patients with multiple myeloma, such as age, hypoproteinemia, severe anemia, paraplegia, amyloidosis, complex karyotype and so on. The risk of early death in the patients with amyloidosis is higher, and salidomide maintenance therapy can help to prolong the life span of the patient.
题目: 临床特征、实验室指标和治疗方案对多发性骨髓瘤患者预后影响的研究.
目的: 研究临床病理特征、实验室指标和治疗方案对多发性骨髓瘤患者预后的影响.
方法: 对本院血液科收治的97例均行化疗的多发性骨髓瘤患者的临床资料进行回顾性分析，记录患者临床病理特征（年龄、性别、重度贫血、轻链型、低蛋白血症、截瘫、肾损伤、淀粉样变、复杂核型、骨病分级、美国东部肿瘤协作组体力状况评分、获得完全缓解等）、实验室指标（C反应蛋白、乳酸脱氢酶、血钙、血β2微球蛋白等）、治疗方案（沙利度胺维持治疗）等指标的情况。随访1-60个月，记录患者总生存期。采用单因素和多因素分析患者总生存期和早期死亡的影响因素，通过Kaplan-Meier法绘制生存曲线，并采用Log-rank检验进行生存分析.
结果: 97例患者中，获得完全缓解29例（29.90%），部分缓解56例（57.73%），总有效率为87.63%（85/97）。截止至末次随访时间，死亡19例（19.59%），1、3、5年生存率分别为80.41%、71.13%、37.11%。中位总生存期29（1-60）个月。单因素分析结果显示，年龄、低蛋白血症、重度贫血、截瘫、肾损伤、淀粉样变、复杂核型、获得完全缓解、沙利度胺维持治疗等均是患者预后的影响因素（P＜0.05）；进一步行多因素Logistic回归分析结果显示，年龄、低蛋白血症、重度贫血、截瘫、淀粉样变、复杂核型、沙利度胺维持治疗均是患者预后的影响因素（P＜0.05）。97例患者中，早期死亡8例。单因素分析结果发现，淀粉样变、重度贫血均是患者早期死亡的危险因素（P＜0.05）；进一步行多因素Logistic回归分析结果显示，淀粉样变是患者早期死亡的独立危险因素（P＜0.05）.
结论: 多发性骨髓瘤患者存在诸多影响预后效果的不良因素，如高龄、伴有低蛋白血症、重度贫血、截瘫、淀粉样变、复杂核型等，其中伴有淀粉样变的患者早期死亡的风险性较高，而采取沙利度胺维持治疗有助于延长患者的生存时间.