初诊多发性骨髓瘤患者CD56表达与以硼替佐米联合来那度胺为基础方案诱导治疗疗效的临床研究

王权钢; 白波; 马梁明; 田卫伟; 李婉婷

doi:10.13201/j.issn.1004-2806.2022.11.014

初诊多发性骨髓瘤患者CD56表达与以硼替佐米联合来那度胺为基础方案诱导治疗疗效的临床研究

- 山西医科大学第三医院血液科(太原，030032)

详细信息

通讯作者: 白波，E-mail：baibo1014@163.com

中图分类号: R733.3

收稿日期: 2022-01-03

刊出日期: 2022-11-01

Clinical study on the expression of CD56 in newly diagnosed multiple myeloma patients and the efficacy of induction therapy based on bortezomib combined with lenalidomide

- Department of Hematology, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China

More Information

Corresponding author: BAI Bo, E-mail: baibo1014@163.com

Received Date: 03 January 2022

Publish Date: 01 November 2022

摘要

摘要: 分析初诊多发性骨髓瘤(MM)患者CD56表达差异与其预后的相关性，以硼替佐米联合来那度胺(VRd)为基础方案诱导治疗疗效的临床研究。回顾性分析山西医科大学第三医院血液科2015年1月—2021年8月初诊MM患者160例，分为CD56表达阳性组(CD56⁺)和CD56表达阴性组(CD56^-)，比较2组临床特征及总生存期(OS)；其中以VRd方案诱导治疗4个疗程的初诊MM患者共64例患者，在4个疗程后进行疗效评估及OS的分析，比较2组疗效评估的差别。CD56⁺组109例(68.1%)，CD56^-组51例(31.9%)；CD56^-组β2微球蛋白(β2-MG)及乳酸脱氢酶水平(LDH)较CD56⁺组更高(P=0.04，P=0.03)；CD56^-组更易发生髓外病变(P < 0.01)；CD56⁺组患者OS更长(P=0.04)；CD56^-、β2-MG≥8 mg/L是MM患者OS的独立预后不良因素(P < 0.05)；经VRd方案治疗后，2组患者预后评估差异无统计学意义(P=0.60)，中位OS差异无统计学意义(P=0.96)；CD56^-组β2-MG和LDH相对CD56⁺组下降更明显(P < 0.05)。由此可见，初诊CD56^-MM患者具有更高的β2-MG和LDH，更易发生髓外侵袭，OS相对较短，经VRd方案诱导治疗的MM患者，2组疗效相当，进行OS分析差异无统计学意义，为CD56^-患者更个体化的治疗提供帮助。
- CD56表达 /
- 多发性骨髓瘤 /
- 硼替佐米 /
- 来那度胺
Abstract: To analyze the correlation between CD56 expression difference and prognosis in newly diagnosed multiple myeloma(MM) patients, and to study the efficacy of bortezomib combined with lenalidomide based induction therapy(VRd). A retrospective analysis was performed on 160 cases of MM newly diagnosed in Third Hospital of Shanxi Medical University hematology department from January 2015 to August 2021, which were divided into CD56 positive group(CD56⁺) and CD56 negative group(CD56^-). The clinical features and overall survival(OS) of the two groups were compared. Among them, a total of 64 newly diagnosed MM patients were treated with VRd for 4 courses. After 4 courses of treatment, efficacy evaluation and OS analysis were conducted. There are 109 cases(68.1%) in CD56⁺group and 51 cases(31.9%) in CD56^-group. The levels of β2 microglobulin(β2-MG) and lactate dehydrogenase(LDH) in CD56^-group were higher than those in CD56⁺group(P=0.04, P=0.03). Extramedullary lesions were more likely to occur in CD56^-group(P < 0.01). The OS in CD56⁺group was longer than that in CD56^-group(P=0.04). CD56^-and β2-MG ≥8 mg/L were the independent adverse influencing factors of OS(P < 0.05). After treatment with VRd regimen, there was no difference in prognosis assessment and median OS between 2 groups(P=0.60). The decrease of β2-MG and LDH in CD56^-group was more obvious than in CD56⁺group(P < 0.05). Above all, Newly diagnosed CD56^-MM patients had higher β2-MG and LDH, were more prone to extramedullary invasion, and had a relatively short OS. For patients with MM treated with VRd regimen, the therapeutic efficacy of CD56⁺group and CD56^-group was similar, and there was no significant difference in OS analysis, providing help for more individualized treatment of CD56^-patients.
- CD56 expression /
- multiple myeloma /
- bortezomib /
- lenalidomide

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图 1 CD56对MM患者OS的影响

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图 2 CD56对VRd治疗MM患者OS的影响

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表 1 2组患者临床特征比较

临床特征	CD56⁺组(n=109)	CD56^-组(n=51)	P
性别/例(%)			0.77
男	55(50.4)	27(52.9)
女	54(49.6)	24(47.1)
年龄/岁	63.3±10.3	65.20±11.3	0.90
血清钙水平/(mmol·L^-1)	2.4±0.8	2.3±0.2	0.84
C反应蛋白/(mg·L^-1)	5.5±2.8	8.9±2.7	0.42
血红蛋白/(g·L^-1)	105.0±32.2	101.0±46.4	0.42
β2-MG/(mg·L^-1)	8.2±3.4	18.5±4.7	0.04
LDH/(U·L^-1)	185.0±32.0	269.0±51.5	0.03
白蛋白/(g·L^-1)	36.1±3.9	34.2±5.2	0.62
Scr/(μmol·L^-1)	121.0±57.2	153.0±42.5	0.31
免疫球蛋白亚型/例(%)			0.07
IgA	17(15.6)	17(33.3)
IgE	11(10.1)	4(7.9)
IgG	62(56.9)	25(49.0)
轻链型	19(17.4)	5(9.8)
ISS分期/例(%)			0.17
Ⅰ、Ⅱ期	72(66.1)	28(54.9)
Ⅲ期	37(33.9)	23(45.1)
髓外病变/例(%)			< 0.01
有	15(13.8)	19(37.3)
无	94(86.2)	32(62.7)

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表 2 MM患者的预后因素分析

预后因素	单因素分析	多因素分析
预后因素	P	HR	95%CI	P
CD56^-	0.04	1.2	0.8~1.7	0.04
ISS分期Ⅲ期	0.02	2.6	1.0~5.3	0.06
LDH≥245 U/L	0.03	1.2	1.0~8.1	0.07
β2-MG≥8 mg/L	0.02	1.9	0.7~12.4	0.03
Scr≥176 μmol/L	0.14

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表 3 2组MM患者治疗后疗效分析例

组别	CR	VGPR	PR	SD	PD
CD56⁺组	2	14	17	11	5
CD56^-组	0	4	5	5	1

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表 4 2组患者治疗后β2-MG、LDH变化 X±S

组别	时间	β2-MG/ (mg·L^-1)	LDH/ (U·L^-1)
CD56⁺组	治疗后	13.5±4.5	108.0±18.1
	治疗前后差值	2.8±6.6	107.0±19.7
CD56^-组	治疗后	20.2±6.7	46.7±41.6
	治疗前后差值	14.0±13.9	191.0±77.1
P		0.01	0.03

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