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新药时代原发性浆细胞白血病预后因素分析

Analysis of the prognostic factors in primary plasma cell leukemia in the era of novel agents

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目的 探讨新药时代原发性浆细胞白血病(pPCL)的预后因素.方法 回顾性收集2011年至2022年就诊于首都医科大学附属北京朝阳医院血液科66例pPCL患者的临床资料,分析其预后因素.结果 66例pPCL患者中位发病年龄为59(29~79)岁.中位总生存(OS)期为19.0(95%CI10.4~27.6)个月,中位无进展生存(PFS)期为11.0(95%CI6.5~15.6)个月.治疗后最佳疗效≥非常好的部分缓解(VGPR)患者的中位OS期和PFS期均显著长于疗效≤部分缓解(PR)患者(中位OS期:33.0个月对6.0个月,P<0.001;中位PFS期:16.0个月对3.0个月,P<0.001).接受自体造血干细胞移植患者的OS期较未接受患者显著延长(49.0个月对6.0个月,P=0.002),PFS期也有延长趋势(19.0个月对8.0个月,P=0.299).接受维持治疗患者的中位OS期、PFS期较未接受维持治疗患者显著延长(中位OS期:56.0个月对4.0个月,P<0.001;中位PFS期:20.0个月对2.0个月,P<0.001).多因素分析结果表明,高钙血症是影响pPCL患者OS的独立危险因素(HR=3.204,95%CI 1.068~9.610,P=0.038);接受维持治疗(HR=0.075,95%CI0.022~0.253,P<0.001)、治疗后疗效≥VGPR(HR=0.175,95%CI0.048~0.638,P=0.008)是影响pPCL患者OS的独立保护因素.结论 在新药时代,高钙血症、接受维持治疗、治疗后疗效≥VGPR是pPCL的独立预后因素.
Objective To explore the prognostic factors of primary plasma cell leukemia(pPCL)in the era of novel agents.Methods The clinical data of 66 patients with pPCL treated at the Department of Haematology,Beijing Chao-Yang Hospital,Capital Medical University from 2011 to 2022 were retrospectively collected to analyze their prognostic factors.Results Among the 66 patients with pPCL,the median age was 59(range:29-79)years.The median overall survival(OS)duration was 19.0(95%CI 10.4-27.6)months,and the median progression-free survival(PFS)duration was 11.0(95%CI 6.5-15.6)months.The median OS and PFS were significantly longer in patients with the best post-treatment response of very good partial remission(VGPR)or better than in patients with a response of partial remission(PR)or worse(median OS:33.0 months vs 6.0 months,P<0.001;median PFS:16.0 months vs 3.0 months,P<0.001).OS was significantly longer in patients who underwent autologous hematopoietic stem cell transplantation than in those who did not undergo transplantation(49.0 months vs 6.0 months,P=0.002),and there was a trend toward a longer PFS in patients who underwent transplantation than in those who did not undergo transplantation(19.0 months vs 8.0 months,P=0.299).The median OS and PFS were significantly longer in patients who received maintenance therapy than in those who did not receive maintenance therapy(median OS:56.0 months vs 4.0 months,P<0.001;median PFS:20.0 months vs 2.0 months,P<0.001).Multivariate analysis showed that hypercalcemia was an independent risk factor(HR=3.204,95%CI 1.068-9.610,P=0.038)for patients with pPCL,while receiving maintenance therapy(HR=0.075,95%CI 0.022-0.253,P<0.001)and post-treatment response of VGPR or better(HR=0.175,95%CI 0.048-0.638,P=0.008)were independent protective factors for patients with pPCL.Conclusions In the era of novel agents,hypercalcemia,receiving maintenance therapy,and post-treatment response of VGPR or better are independent prognostic factors for pPCL.

Leukemia,plasma cellPrognosisHypercalcemiaMaintenance therapyTreatment outcome

邓晶晶、金小云、张之尧、周慧星、杨光忠、耿传营、菅原、陈文明、高文

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首都医科大学附属北京朝阳医院,北京 100020

白血病,浆细胞 预后 高钙血症 维持治疗 治疗结果

北京市自然科学基金

7212041

2024

中华血液学杂志
中华医学会

中华血液学杂志

CSTPCD北大核心
影响因子:1.17
ISSN:0253-2727
年,卷(期):2024.45(7)