多发性骨髓瘤182例临床分析
Clinical study of multiple myeloma: a report of 182 cases
目的 探讨多发性骨髓瘤(MM)两种分期系统对我国患者的适用性及影响MM生存的预后因素,分析主要治疗方案的疗效和长期生存.方法 182例MM患者按照Durie-Salmon(DS)和国际分期系统(ISS)比较了生存情况,对14项临床和实验室指标进行了单因素和多因素分析.回顾性分析了主要治疗方案(VAD样、MP/MPT、包含硼替佐米的方案等)的疗效和总生存期(OS)、无进展生存期(PFS)等.结果 DS分期Ⅰ、Ⅱ、Ⅲ期患者中位生存期分别为79、82、43个月,Ⅰ和Ⅱ/Ⅲ期间差异无统计学意义.ISS分期Ⅰ、Ⅱ、Ⅲ期患者中位生存期分别为79、49和43个月.Ⅰ和Ⅱ/Ⅲ期之间P值分别为0.042和0.020多因素分析显示年龄、骨髓浆细胞数、C反应蛋白(CRP)、B2微球蛋白(β2-MG)是影响生存的独立预后因素.182例MM患者的总有效率为69.2%.总中位生存期为(49.0±5.0)个月,PP3(19.0±2.1)个月,5年OS 34%,10年OS 19%.VAD样方案联合沙利度胺(VAD样+Thal)的总反应率、中位OS、中位PFS明显高于单用VAD样方案(VAD样-Thal),分别为81.5%vs 59.7%,(79.0±29.5) vs (37.0±4.8)个月,(24.0±6.0) vs (14.0±2.7)个月(P=0.008.0.001和0.033).结论 ISS分期较DS分期更适合我国患者,特别对于低危患者.VAD样方案联合Thal作为MM一线治疗方案,疗效可靠.诱导治疗加用Thai不仅可以提高总反应率,还可以延缓复发或进展,延长生存.
更多Objective To explore the applicability of Durie Salmon ( DS) and International Staging System (ISS) for Chinese patients with multiple myeloma (MM) and to evaluate the efficacy of major therapeutic options and the influence of various prognostic factors on survival were also evaluated. Methods The patient survival was compared with wegards to DS and ISS. Fourteen clinical and laboratory parameters were analyzed by univariate and multivariate process. Response rate, overall survival (OS) and progression- free survival (PFS) of 182 patients treated with different regimens were retrospectively analyzed. Results The median survival of patients with DS stages Ⅰ ,Ⅱ and Ⅲ were 79, 82 and 43 months, respectively. There was no significance between stage Ⅰ and Ⅱ /Ⅲ. The median survival of patients with ISS stages Ⅰ , Ⅱ and Ⅲ were 79, 49 and 43 months, respectively. Multivariate analysis suggested that age, percentage of plasma cell in bone marrow, C-neactive protein (CRP) and p2-microglobulin (2-MG) were independent prognostic factors for OS. The overall response rate (ORR) of 182 patients was 69. 2% and median OS and PFS were 49. 0 ±5. 0 and 19. 0 ±2. 1 months, respectively. The 5- and 10-year OS were 34% and 19% , respectively. Compared with those not receiving thalidomide induction, the patients on a VAD-like regimen combined with thalidomide showed a superior ORR (81. 5% vs 59. 7% , P = 0. 008) , a longer OS (79. 0 ± 29.5 vs 37.0 ±4.8 months, P = 0. 001) and a longer PFS (24.0 ±6.0 vs 14.0 ±2.7 months, P = 0. 033). Conclusion ISS is more applicable than DS, especially for low risk patients. The efficacy of VAD-like regimen combined Thal as first-line treatment is proven to be reliable. Induction therapy including thalidomide can not only improve the ORR, but also delay the relapse or progression of disease. It may even prolong the patient survival.
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