Clinical Analysis Of FISH Test,Clinical Characteristics And Prognosis In Patients With Multiple Myeloma

BackgroundMultiple myeloma（MM）is the second most common malignant disease in the blood system,which is common and incurable in elderly patients.The incidence rate is increasing.Accurate risk stratification helps to identify high-risk patients and early intervention.Genetic abnormalities can be detected in more than half of MM patients,which are closely related to disease progression and prognosis.At present,most of the patients benefit from the new drugs advocated,but whether they can resist the adverse effects of genetic high-risk factors on the prognosis is still uncertain.ObjectivesTo explore the factors influencing the prognosis of patients with primary treatment of multiple myeloma,and to provide the basis for the selection of individualized treatment plan.Methods41 newly treated MM patients in Hematology Department of the First Affiliated Hospital of Xinxiang Medical College were collected from February 2016 to April2019.Fluorescence in situ hybridization（FISH）was used to detect 1q21 amplification,13q14 deletion,IgH rearrangement and p53 deletion.The clinical data of the patients were collected:age,gender,blood routine,blood biochemistry,M protein,β₂-microglobulin,immunoglobulin electrophoresis,bone marrow cytology,imageological examination,treatment plan and curative effect.SPSS 20.0 was used to analyze the data.The counting data were compared byc2 test or Fisher exact probability method,and the survival curve was drawn by Kaplan Meier method,and log rank method was used to test the difference of survival rate.Cox regression analysis was used for multivariate analysis,P<0.05 indicated that the statistics were significant.Results1.Among 41 MM patients,70.73%（29/41）had abnormal cytogenetics.The positive rates of 1q21 amplification,13q14 deletion,P53 deletion and IGH rearrangement were 53.66%（22/41）,39.02%（16/41）,2.44%（1/41）and 36.59%（15/41）,respectively,48.78%（20/41）had two or more abnormal genes.2.There were more females and lower hemoglobin levels in 13q14 deletion positive patients than in males.The hemoglobin of patients with positive IgH rearrangement was lower than that of the negative group,and the corrected serum calcium level was higher than that of the negative group（P<0.05）.No correlation between 1q21 amplification and clinical features was found.3.Among 29 patients with genetic abnormality,the effective rate of patients with two or more genetic abnormalities is lower than that of patients with only one gene abnormality（35.00%vs.88.89%,P=0.014）.In the traditional chemotherapy group,the effective rate of patients with 13q14 deletion and 1q21 amplification positive was lower than that of patients with negative（0.00%vs.85.71%,P=0.00;14.29%vs.83.33%,P=0.03）.In bortezomib group,the effective rate of 13q14 deletion positive group was lower than that of negative group（40.00%vs.94.44%,P<0.05）.There was no significant difference in effective rate between positive and negative groups in1q21 amplification group（P>0.05）.4.Univariate analysis results showed that Alb<35g/L,β₂-MG≥3.5g/L,Ca≥2.75mmol/L,HB<85g/L,del（13q14）,IGH rearrangement,ISS stageⅢwere related to short PFS;and HB<85g/L,Cr≥177umol/L,del（13q14）,IGH rearrangement were related to short OS.5.The results of multivariate analysis showed that IgH rearrangement was an independent risk factor for PFS and OS.PFS was shortened in MM patients with LDH≥245IU/L,13q14 deficiency and traditional chemotherapy.ConclusionThe cytogenetic abnormality is related to the clinical characteristics and curative effect of MM patients,which can reflect the tumor burden to a certain extent.Patients with 1q21 amplification and 13q14 deletion have slightly poor efficacy,and the more types of genetic abnormalities,the worse of the efficacy.The chemotherapy with bortezomib can improve the efficacy of 1q21 amplification patients.LDH,13q14 deletion,and IGH rearrangement are the influencing factors of PFS and OS in MM patients.