循环浆细胞对多发性骨髓瘤患者预后的影响

Effect of circulating plasma cell on the prognosis of patients with multiple myeloma

摘要

目的：探索循环浆细胞（circulating plasma cell,CPC）对多发性骨髓瘤（multiple myeloma,MM）预后的影响，结合CPC与RISS分期（Revised International Staging System），建立并验证改良的CPC-RISS分期系统。方法：回顾性收集2006年1月至2023年6月在中国人民解放军空军军医大学第一附属医院血液科治疗的639例初治MM患者的临床数据，利用外周血涂片来计算患者CPC比例，分析CPC等相关因素对MM患者预后的影响，结合RISS分期与CPC比例建立CPC-RISS分期系统，分析不同分期患者生存及预后差异。结果：与无CPC的患者相比，可检测的CPC与MM的诸多高危因素显著相关，存在CPC的MM患者完全缓解率更低，总生存期、无进展生存期更短。本研究使用改良CPC-RISS分期系统将MM患者分为4期，不同分期MM患者中位生存期和无进展生存期差异有统计学意义。结论：存在CPC的MM患者表现出更具侵袭性的特征，对治疗反应较差，长期生存率降低，改良的CPC-RISS分期系统可有效预测初治MM患者预后。

Abstract

Objective To investigate the effect of circulating plasma cell（CPC） on the prognosis of multiple myeloma（MM），and to establish and validate a modified CPC-RISS staging system based on CPC and RISS. Methods A retrospective analysis was performed for the clinical data of 639 treatment-naïve patients with MM who were treated in Department of Hematology，Xijing Hospital，from January 2006 to June 2023. Peripheral blood smear was used to calculate the percentage of CPC in patients，and the impact of CPC and other related factors on the prognosis of MM patients was analyzed. A CPC-RISS staging system was established based on RISS stage and the percentage of CPC，and the differences in survival and prognosis were analyzed between patients with different stages. Results Compared with the patients without CPC，detectable CPC was significantly associated with various high-risk factors for MM，and the MM patients with CPC had a lower complete remission rate and shorter overall survival time and progression-free survival time. The modified CPC-RISS staging system was used to classify the patients with MM into four stages，and there were significant differences in median survival time and progression-free survival time between the patients with different stages of MM. Conclusion The MM patients with the presence of CPC exhibit more aggressive features，worse response to treatment，and a reduction in long-term survival rate. The modified CPC-RISS staging system can effectively predict the prognosis of treatment-naïve MM patients.

Graphical abstract

关键词

多发性骨髓瘤 / 循环浆细胞 / 预后 / 分期系统

Key words

multiple myeloma / circulating plasma cell / prognosis / staging system

基金资助

陕西省卫生健康血液肿瘤疾病科研创新团队资助项目(2023TD-03)