Efficacy of radiotherapy for newly diagnosed multiple myeloma with extramedullary disease
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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. -
Key words:
- multiple myeloma /
- radiotherapy /
- extramedullary disease /
- 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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[1] Bladé J, de Larrea CF, Rosiñol L. Extramedullary involvement in multiple myeloma[J]. Haematologica, 2012, 97(11):1618-1619. doi: 10.3324/haematol.2012.078519 [2] International Myeloma Working Group. Criteria for the classification of monoclonal garnmopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group [J]. Br J Haemato1, 2003, 121(5):749-757. doi: 10.1046/j.1365-2141.2003.04355.x [3] Bladé J, Samson D, Reece D, et al. Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation. Myeloma Subcommittee of the EBMT. European Group for Blood and Marrow Transplant[J]. Br J Haematol, 1998, 102(5):1115-1123. doi: 10.1046/j.1365-2141.1998.00930.x [4] Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008[J]. Int J Cancer, 2010(127): 2893-2917. http://www.cabdirect.org/abstracts/20113016175.html [5] Tan D, Chng WJ, Chou T, et al. Management of multiple myeloma in Asia: resource-stratified guidelines[J]. Lancet Oncol, 2013, 14 (12):e571-581. doi: 10.1016/S1470-2045(13)70404-2 [6] Weinstock M, Ghobrial IM. Extramedullary multiple myeloma[J]. Leuk Lymphoma, 2013, 54(6):1135-1141. doi: 10.3109/10428194.2012.740562 [7] Damaj G, Mohty M, Vey N, et al. Features of extramedullary and extraosseous multiple myeloma: a report of 19 patients from a single center[J]. Eur J Haematol, 2004, 73(6):402-406. doi: 10.1111/j.1600-0609.2004.00331.x [8] Varettoni M, Corso A, Pica G, et al. Incidence, presenting features and outcome of extramedullary disease in multiple myeloma: a longitudinal study on 1003 consecutive patients[J]. Ann Oncol, 2010 (21):325-330. http://europepmc.org/abstract/MED/19633044 [9] Cerny J, Fadare O, Hutchinson L, et al. Clinicopathological features of extramedullary recurrence/relapse of multiple myeloma[J]. Eur J Haematol, 2008, 81(1):65-89. doi: 10.1111/j.1600-0609.2008.01087.x [10] 张翼鷟, 智亚芹, 王亚非, 等.初诊时伴发髓外病变的多发性骨髓瘤预后因素分析[J].中华医学杂志, 2012, 92(34):2415-2418. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhyx201234011Zhang YZ, Zhi YQ, Wang YF, et al. Clinical features and outcome analyses of newly-diagnosed multiple myeloma with extramedullary involvements[J]. Nat Med J China. 2012, 92(34):2415-2418. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhyx201234011 [11] Yasuda H, Ando J, Sato E, et al. Successful treatment of extramedullary tumors with low-dose thalidomide in patients with multiple myeloma[J]. Intern Med, 2010, 49(23):2617-2620. doi: 10.2169/internalmedicine.49.4215 [12] 郭姗琦, 智亚芹, 晋鑫, 等.沙利度胺治疗132例初诊时伴或不伴髓外病变多发性骨髓瘤的疗效比较[J].白血病·淋巴瘤, 2013, 22(1):53-56. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=bxblbl201301018Guo Shanqi, ZHI Yaqin, JIN Xin, et al. Efficacy comparision of thalidomide for 132 cases of newly diagnosed multiple myeloma with or without extramedullary disease[J]. Journal of Leukemia & Lymphoma. 2013, 22(1):53-56. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=bxblbl201301018 [13] Bladé J, Fernández de Larrea C, Rosiñol L, et al. Soft-tissue plasmacytomas in multiple myeloma: incidence, mechanism of extarmedullary spread, and treatment approach[J]. J Clin Oncol, 2011, 29(28): 3805-3812. doi: 10.1200/JCO.2011.34.9290 [14] Moriuchi M, Ohmachi K, Kojima M, et al. Three cases of bortezomib-resistant multiple myeloma with extramedullary masses[J]. Tokai J Exp Clin Med, 2010, 35(1):17-20. http://europepmc.org/abstract/MED/21319020 [15] Sher T, Miller KC, Deeb G, et al. Plasma cell leukaemia and other aggressive plasma cell malignancies[J]. Br J Haematol, 2010, 150(4): 418-427. doi: 10.1111/j.1365-2141.2010.08157.x [16] Suh YG, Suh CO, Kim JS, et al. Radiotherapy for solitary plasmacytoma of bone and soft tissue: outcomes and prognostic factors[J]. Ann Hematol, 2012, 91(11):1785-1793. doi: 10.1007/s00277-012-1510-6 [17] Aguado B, Iñigo B, Sastre JL, et al. Extramedullary plasmacytomas in the context of multiple myeloma[J]. Adv Ther, 2011, 28(7):7-13. http://www.ncbi.nlm.nih.gov/pubmed/22105528 [18] Oriol A. Multiple myeloma with extramedullary disease[J]. Adv Ther, 2011, 28(7):1-6. http://europepmc.org/articles/PMC3736849/