Objective: To investigate the effect of clinical baseline data on prognosis in patients with multiple myeloma (MM) complicated by extramedullary disease (EMD).
Methods: The clinical data of 46 MM patients with EMD were retrospectively analyzed. The clinical data and survival prognosis of MM patients in primary EMD group and recurrent EMD group were analyzed. The classified baseline data were expressed by the number of cases (percentage), the χ2 test was used to compare the two classification data groups. The OS and PFS curves were drawn by multiplication positive limit method (Kaplan-Meier). Log-rank test was used for the univariate analysis of prognosis, and COX proportional risk regression model was used for the multiple factors of prognosis.
Results: β 2 microglobulin≥2.7 g/L, lactic dehydrogenase≥250 U/L, serum calcium≥2.75 mmol/L, plasma cells in bone marrow≥60% were the poor prognostic factors for PFS. Serum calcium≥2.75 mmol/L and the plasma cells in bone marrow≥60% were the poor prognostic factors for OS. Multivariate regression analysis enroling the statistically significant factors in univariate analysis baseline date in factors in showed that plasma cell level≥60% in bone marrow was independent poor prognostic factors for PFS, and serum calcium≥2.75 mmol/L was an independent poor prognostic factor for OS. The IgG type is the most common type of MM complicated by EMD. The remission depth of primary EMD group≥VGPR was lower than that of recurrent EMD group, and there was significant difference between the two groups (P<0.05), and the median OS time of patients with primary EMD group was shorter than that of patients with recurrent EMD group, the difference was statistically significant (P<0.05). The 3-year survival rates of primary EMD group and recurrent EMD group were 10.0% and 34%, respectively, there was no significant difference between the two groups (P>0.05). The 5-year survival rate was 0 and 20%, respectively, there was significant difference between the two groups (P<0.05).
Conclusion: The remission depth of primary EMD group≥VGPR is lower than that of recurrent EMD group，and the OS time of patients in primary EMD group is shorter than that in recurrent EMD group. Bortezomib-based chemotherapy could not improve the prognosis of patients with primary EMD and recurrent EMD, and the prognosis of patients with primary EMD is even worse.
题目: 多发性骨髓瘤伴髓外病变46例临床分析.
目的: 探讨多发性骨髓瘤（MM）伴髓外病变（EMD）患者临床基线资料对预后的影响.
方法: 回顾性分析伴髓外病变的46例MM患者的临床资料，分析初次住院时原发性EMD组和复发EMD组MM患者临床资料及生存预后的差异。分类基线资料采用例数（百分比）表示，二分类资料组间比较采用χ2检验，生存分析采用乘积极限法（Kaplan-Meier）绘制OS和PFS曲线；Log-rank检验用于预后单因素分析，采用COX比例风险回归模型进行预后多因素分析.
结果: β 2微球蛋白≥2.7 g/L、乳酸脱氢酶≥250 U/L、血清钙≥2.75 mmol/L、骨髓中浆细胞比例≥60%是影响患者PFS的不良预后因素；血清钙≥2.75 mmol/L、骨髓中浆细胞比例≥60% 是影响患者OS的不良预后因素。将单因素分析中有统计学意义基线资料纳入多因素回归分析显示，骨髓中浆细胞≥60% 为影响患者PFS独立不良预后因素，血清钙≥2.75 mmol/L为影响患者OS独立不良预后因素。MM伴发EMD者以IgG型居多。原发性EMD组缓解深度达到≥VGPR较复发EMD组低，2组比较差异有统计学意义（P<0.05）。原发性EMD组中位OS时间短于复发EMD组，差异有统计学意义（P<0.05）；原发性EMD组和复发EMD组患者3年生存率分别为10.0%和34.0%，2组比较差异无统计学意义（P>0.05），5年生存率分别为0和20%，2组比较差异有统计学意义（P<0.05）.
结论: 原发性EMD组缓解深度达到≥VGPR较复发EMD组低；原发性EMD组OS时间短于复发EMD组。以硼替佐米为基础化疗方案未能改善原发性EMD组和复发EMD组患者预后，原发性EMD组患者的预后更差.