Clinical Characteristics and Prognostic Analysis of Newly Diagnosed Multiple Myeloma Accompanied with Extramedullary Disease
Objective To compare the clinical characteristics and laboratory indexes,response to different treatment schemes,sur-vival of newly diagnosed multiple myeloma(NDMM)patients with bone-related extramedullary disease(bEMD)and strict extramedul-lary disease(sEMD),and to explore the factors affecting their prognosis.Methods Seventy-five patients with NDMM with extramedul-lary disease(EMD)admitted to the Affiliated Hospital of Xuzhou Medical University from February 2017 to February 2023 were retrospec-tively selected,including 58 patients with bEMD and 17 patients with SEMD,and 50 patients with NDMM without EMD admitted during the same period were included in the non-EMD group.Compare the differences in clinical data among three groups,Kaplan-Meier method was used to draw the survival curve,and Log-rank test was used to compare the groups.COX proportional risk model was used for multivariate analysis.Results The median follow-up was 26(3-59)months,the median overall survival(OS)of patients in the non-EMD,bEMD,and sEMD groups was not reached,56months,and 13months,respectively,and the difference was statistically sig-nificant(P＜0.001).The median progression free survival(PFS)was 24months,17months,and 10months,respectively,and the difference was statistically significant(P=0.002).Multivariate COX regression analysis showed that sEMD(P=0.032),monocyte to lymphocyte ratio(MLR)≥0.32(P=0.035),and 1 q21 amplification(P=0.006)were independent risk factors affecting OS.1 q21 am-plification(P=0.033)was an independent risk factor affecting PFS.The difference in OS(P=0.007)and PFS(P＜0.001)between the 20 patients in the bEMD group who underwent sequential autologous hematopoietic stem cell transplantation(ASCT)after induction chemotherapy and those who did not undergo transplantation after chemotherapy was statistically significant.Conclusion sEMD,MLR and 1 q21 amplification are independent risk factors affecting OS in NDMM patients with EMD,while 1 q21 amplification is an independent risk factor affecting PFS.Sequential ASCT after induction chemotherapy may improve the poor prognosis of bEMD to some extent.
万方数据
维普
