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

袁田; 郭姗琦; 智亚芹; 李倩; 夏冰; 王亚非; 张翼鷟; 王平

doi:10.3969/j.issn.1000-8179.20140931

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

doi: 10.3969/j.issn.1000-8179.20140931

袁田^①,,
郭姗琦^①,
智亚芹^①,
李倩^①,
夏冰^①,
王亚非^①, ,,
张翼鷟^①,
王平^②

①.
天津医科大学肿瘤医院血液科，国家肿瘤临床医学研究中心，天津市肿瘤防治重点实验室（天津市 300060）
②.
天津医科大学肿瘤医院放疗科，国家肿瘤临床医学研究中心，天津市肿瘤防治重点实验室（天津市 300060）

详细信息

作者简介:
袁田医学博士，住院医师。研究方向为血液肿瘤的临床诊疗及基础。E-mail：mdyuantian@163.com

通讯作者:
王亚非 drwang2005@163.com

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出版历程
- 收稿日期: 2014-05-03
- 修回日期: 2014-06-03
- 刊出日期: 2014-07-15

Efficacy of radiotherapy for newly diagnosed multiple myeloma with extramedullary disease

YUAN Tian^{①
,},
GUO Shanqi^①,
ZHI Yaqin^①,
LI Qian^①,
XIA Bing^①,
WANG Yafei^{①
, ,},
ZHANG Yizhuo^①,
WANG Ping^②

①.
Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin 300060, China
②.
Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China

More Information

Corresponding author: Yafei WANG; E-mail: drwang2005@163.com

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。
- 多发性骨髓瘤 /
- 放疗 /
- 髓外病变 /
- 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.
- multiple myeloma /
- radiotherapy /
- extramedullary disease /
- prognosis

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图 1 放疗组与未放疗组预计OS

Figure 1. Overall survival rate of radiotherapy and non-radiotherapy groups

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图 2 单因素分析多发性骨髓瘤患者的预后不良指标

Figure 2. Prognostic analysis of multiple myeloma by univariate analysis

A. Relationship of Hb level with the prognosis; B. Relationship of β2-MG level with prognosis

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表 1 44例伴髓外病变多发性骨髓瘤疗效评价例（%）

Table 1. Therapy and response criteria evaluation of 44 multiple myeloma patients with extramedullary disease n (%)

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