Analysis of clinical characteristics and prognosis of 39 patients with multiple myeloma under 50 years old
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摘要: 目的 探讨50岁以下多发性骨髓瘤(multiple myeloma，MM)患者的临床表现及预后。方法 回顾性分析2011年11月—2022年11月本院收治的39例50岁以下初治MM患者的临床资料及实验室指标，探索影响生存和预后的因素，并与既往已发表的国外研究数据进行比较。结果 50岁以下MM患者占同时期初治MM患者的21.5%(39/181)，该部分患者国际分期系统(ISS)Ⅲ期比例为46.2%(18/39)、轻链型占30.8%(12/39)、贫血占56.4%(22/39)、肾功能不全占30.8%(12/39)。中位随访36(3~160)个月，中位无进展生存期为35个月，总生存期未达到。单因素分析显示，血钙、乳酸脱氢酶、自体造血干细胞移植和最佳缓解深度均是无进展生存期和总生存期的影响因素(P < 0.05)。多因素分析显示，乳酸脱氢酶升高(HR=7.356，95%CI 1.288~41.998，P=0.025)是总生存期预后不良的独立影响因素。结论 与国外数据相比，本中心年轻初治MM患者的比例更高，且ISS Ⅲ期、轻链型、贫血及肾功能不全的比例亦更高。患者预后大多较好，乳酸脱氢酶是总生存期预后不良的独立危险因素。Abstract: Objective To investigate the clinical characteristics and prognosis of young patients(younger than 50 years of age) with multiple myeloma(MM).Methods The clinical characteristics and outcome of 39 newly diagnosed MM patients younger than 50 years of age admitted to our hospital from November 2011 to November 2022 were retrospectively analyzed, and the factors that affected survival and prognosis compared with previously published foreign research data were evaluated.Results Patients under 50 years old accounted for 21.5%(39/181) of MM patients with initial treatment at the same period, and the proportion of these patients in international stage Ⅲ system was 46.2% (18/39), light chain type accounted for 30.8%(12/39), anemia accounted for 56.4%(22/39), and renal insufficiency accounted for 30.8%(12/39). Patients were followed-up for the median period of 36(3-160) months. The median progression-free survival was 35 months, and the median overall survival was not attained. Univariate analysis showed that calcium, lactic dehydrogenase, autologous hematopoietic stem cell transplantation and the best of response were all influencing factors for the progression-free survival and the overall survival(P < 0.05). Multivariate analysis showed that elevated lactic dehydrogenase was an independent influencing factor for poor overall survival prognosis(HR=7.356, 95%CI 1.288-41.998, P=0.025).Conclusion Compared with previously published foreign research data, the proportion of MM in young patients may be higher, and the proportion of ISS stage Ⅲ, light chain type, anemia and renal insufficiency is higher, and the prognosis is better.
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Key words:
- multiple myeloma /
- age of onset /
- clinical feature /
- survival time
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表 1 年龄 < 50岁NDMM患者的基线临床特征
临床特征 例(%) 临床特征 例(%) 年龄/岁 42(26~49) 髓外病变 性别 有 8(20.5) 男 27(69.2) 无 31(79.5) 女 12(30.8) FISH检查 M蛋白类型 del(17p13) IgG 14(35.9) 异常 2(5.1) IgA 11(28.2) 无异常 37(94.9) 轻链型 12(30.8) 1q21+ 非分泌型 2(5.1) 异常 10(25.6) ISS分期 无异常 29(74.4) Ⅰ期 15(38.4) t(4;14) Ⅱ期 6(15.4) 异常 3(7.7) Ⅲ期 18(46.2) 无异常 36(92.3) 血红蛋白 t(14;16) < 100 g/L 22(56.4) 异常 4(10.3) ≥100 g/L 17(43.6) 无异常 35(89.7) 血肌酐 t(11;14) ≤135 μmol/L 27(69.2) 异常 4(10.3) >135 μmol/L 12(30.8) 无异常 35(89.7) 血清钙 FISH高危遗传学异常 ≤2.75 mmol/L 26(66.7) 高危△ 19(48.7) >2.75 mmol/L 13(33.3) 标危 20(51.3) LDH 移植 ≤250 U/L 27(69.2) 是 17(43.6) >250 U/L 12(30.8) 否 22(56.4) 骨质破坏 有 29(74.4) 无 10(25.6) △高危细胞遗传学异常包括：1q21+、del(17p)、t(4；14)、t(14；16)。 
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表 2 年轻NDMM患者预后的单因素分析
影响因素 PFS OS HR(95%CI) P HR(95%CI) P 血红蛋白(< 100 g/L) 0.781(0.323~1.890) 0.584 1.524(0.437~5.318) 0.508 血肌酐(>135 μmol/L) 2.253(0.956~5.309) 0.063 2.719(0.784~9.435) 0.115 血清钙(>2.75 mmol/L) 3.208(1.286~7.999) 0.012 6.437(1.633~25.380) 0.008 LDH(>250 U/L) 2.902(1.220~6.905) 0.016 8.865(2.176~36.119) 0.002 ISS分期 Ⅰ期 1.000 1.000 Ⅱ期 2.971(0.922~9.575) 0.068 1.281(0.116~14.164) 0.840 Ⅲ期 1.656(0.622~4.410) 0.313 3.930(0.809~19.091) 0.090 骨质破坏 1.334(0.484~3.673) 0.577 1.368(0.290~6.455) 0.692 髓外病变 1.073(0.359~3.204) 0.900 2.164(0.553~8.475) 0.268 FISH高危型 1.370(0.584~3.218) 0.469 3.208(0.822~12.522) 0.093 auto-HSCT 0.363(0.146~0.900) 0.029 0.107(0.013~0.847) 0.034 缓解深度 完全缓解 0.011(0.001~0.110) < 0.001 0.001(0.437~5.766) < 0.001 非常好的部分缓解 0.016(0.002~0.156) < 0.001 0.037(0.006~0.244) 0.037 部分缓解 0.019(0.002~0.212) 0.001 0.082(0.012~0.576) 0.082 部分缓解以下 1.000 1.000
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表 3 年轻NDMM患者预后的多因素分析
影响因素 PFS OS HR(95%CI) P HR(95%CI) P 血清钙(>2.75 mmol/L) 2.022(0.715~5.718) 0.184 2.823(0.555~14.372) 0.211 LDH(>250 U/L) 2.786(0.995~7.804) 0.051 7.356(1.288~41.998) 0.025 最佳缓解深度(≥非常好的部分缓解) 0.507(0.174~1.480) 0.214 0.226(0.038~1.325) 0.099 auto-HSCT 0.413(0.140~1.220) 0.110 0.209(0.019~2.350) 0.205
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