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初诊时免疫评分对应用硼替佐米的多发性骨髓瘤患者预后的影响

Effect of immune score at initial diagnosis in predicting prognosis in patients with multiple myeloma treated with bortezomib

    摘要
  • 摘要:
      目的  探讨淋巴细胞/单核细胞比值（LMR）、正常免疫球蛋白（u-Ig）水平及免疫评分对接受硼替佐米治疗的初诊多发性骨髓瘤（MM）患者的影响。
      方法  回顾性分析201例初诊MM患者临床资料。根据LMR相关参考文献截止值，将患者分为低LMR组（LMR < 3.6）和高LMR组（LMR≥3.6）。根据u-Ig（IgG、IgA、IgM）水平降低情况，将患者分为u-Ig正常组、u-Ig降低1组（1项指标低于正常值的下限）和u-Ig降低2组（2项及以上指标低于正常值的下限）。建立免疫分组，包括低危组、中危组、高危组。分析治疗前LMR和u-Ig分组患者的基线数据、客观缓解率（ORR）及总生存期（OS）。分析MM患者相关预后不良独立因素。
      结果  低危组ORR高于中危组及高危组，差异有统计学意义（P=0.044，P=0.007）。年龄≥65岁、国际分期体系（ISS）Ⅲ期、血小板≤100×109/L、乳酸脱氢酶（LDH）>250 U/L、LMR < 3.6、u-Ig降低1项、u-Ig降低≥2项、免疫中危和高危是影响MM患者的预后不良独立因素。
      结论  在硼替佐米应用中，免疫评分对MM患者的治疗反应及预后具有良好效能，可作为早期识别高危患者的参考。

     

    Abstract:
      Objective  To investigate the effect of the lymphocyte-to-monocyte ratio (LMR), uninvolved immunoglobulin (u-Ig) levels and immune scores for newly diagnosed multiple myeloma (MM) patients treated with bortezomib.
      Methods  The clinical data of 201 newly diagnosed MM patients was retrospectively analyzed. Patients were divided into low LMR group (LMR < 3.6) and high LMR group (LMR≥3.6) according to the cutoff value of LMR related references. According to the reduced levels of u-Ig (IgG, IgA, IgM), the patients were divided into normal u-Ig group, one index of u-Ig reduced group (one index was lower than the lower limit of normal value) and two indexes of u-Ig reduced group (two or more indicators were lower than the lower limit of normal value). Immunization groups were established, including low risk group, medium risk group and high risk group. Baseline data, objective response rate (ORR) and overall survival (OS) of patients of LMR groups and u-Ig groups before treatment were analyzed. Independent factors of poor prognosis related to OS in MM patients were analyzed.
      Results  The ORR of low-risk group was significantly higher than that of medium-risk group and high-risk group(P=0.044, P=0.007). Aged 65 years and above, International Staging System (ISS) stage Ⅲ, platelet ≤100×109/L, lactate dehydrogenase (LDH) >250 U/L, LMR < 3.6, u-Ig decreased by one item, u-Ig decreased by ≥2 items and immunization medium risk as well as high risk were independent adverse prognostic factors affecting the OS in MM patients.
      Conclusion  In the application of bortezomib, the immune score has a good effect on the treatment response and prognosis of MM patients, and can be used as a reference for early identification of high-risk patients.

     

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