放疗对初诊时伴髓外病变的多发性骨髓瘤患者的疗效分析

Efficacy of radiotherapy for newly diagnosed multiple myeloma with extramedullary disease

    摘要
  • 摘要:
      目的  分析放疗对初诊时伴髓外病变的多发性骨髓瘤（MM）患者的疗效及对预后的影响。
      方法  回顾性分析本院自2000年1月至2012年8月收治的52例初诊时伴有髓外病变的多发性骨髓瘤患者的临床特点及其预后相关因素，分析放疗疗效及对预后的影响。
      结果  52例患者中位年龄60（31~81）岁，髓外病变最多见于软组织（69.2%）。其中13例患者接受放疗，中位放疗剂量45 Gy。患者预计总生存（OS）时间为42.5个月。而接受放疗与否对患者总缓解率及预后差异均无统计学意义（P > 0.05）。单因素分析显示Hb≤110 g/L（P=0.009）、β2-MG≥5.5（P=0.049）为该类患者预后不良指标；Cox多因素分析显示，仅β2-MG为本组患者的独立预后因素（P=0.014）。
      结论  放疗不能改善初诊时伴髓外病变的MM患者的预后，可能需要联合硼替佐米等新药或进行自体造血干细胞移植来改善预后。

     

    Abstract:
      Objective   To investigate the clinical efficiency and effect of radiotherapy on newly diagnosed multiple myeloma (MM) with extramedullary disease.
      Methods   The clinical features and prognostic factors were retrospectively analyzed in 52 patients hospitalized from January 2000 to August 2012 in Tianjin Medical University Cancer Institute and Hospital. We analyzed the efficiency of radiotherapy and its effect on the prognosis of MM patients with extramedullary disease.
      Results   The median age among the 52 patients was 60 years, 69.2% extramedullary multiple myeloma (EM) was found in soft tissues. Among all the EM patients, 13 accepted radiotherapy with a median radiotherapy dose of 45 Gy. The estimated overall survival (OS) of patients with EM was 42.5 months. Radiotherapy did not show statistically significant influence both on disease response rate and overall survival (P > 0.05). Log-rank univariate analysis showed that Hb≤110 g/L (P=0.009) and β2-MG≥5.5 (P=0.049) were poor prognostic factors of MM. Multivariate analysis with COX model showed that β2-MG was statistically significant (P=0.014).
      Conclusion   Radiotherapy does not improve the prognosis of patients with EM. Furthermore, patients with EM may need combination therapy, which includes administration of Bortezomib or autologous hemopoietic stem cell transplantation.

     

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