| ObjectiveTo analyze the clinical features,treatment efficacy and the prognostic factors on survival of 375 patients with newly diagnosed multiple myeloma(NDMM)retrospectively.MethodsThe clinical data of 375 NDMM patients were collected from January 2005 to June 2018 in Qilu Hospital of Shandong University.The patients were diagnosed in accordance with International Myeloma Working Group(IMWG)criteria and staged according to International Staging System(ISS).All the patients received minimal 2-cycles induction therapy.This study analyzed the clinical features retrospectively,assessed the therapy efficacy and conducted the survival analysis on the basis of clinical features,laboratory indexes and treatment efficacy.Kaplan-Meier curves were used for univariate survival analysis,and the log-rank test was used to compare survival differences between subgroups.The COX proportional hazard model was used for multivariate survival analysis.P<0.05 was considered a significant difference.Results1.375 patients concluded 209 males and 166 females.The median age of all patients was 57 years(27-82),and the number of annual patients was increasing from 2010.239(63.7%)cases appeared bone pain that is the first common symptoms of all the patients,followed by fatigue(35.4%).The most common monoclonal protein was IgG(48.5%)type,followed by IgA(23.2%)type,light chain(22.4%)type,IgD(3.5%)type,non-secretory(2.4%)type.Of the patients,345 cases were staged by ISS with 85(24.6%),112(32.5%)and 148(42.9%)for stages ?,? and ?.Of the 369 patients that were tested,56.9%patients were diagnosed with anemia(hemoglobin<100g/L,and 12.7%patients with thrombocytopenia(platelets<100×10^12/L).Of the 345 patients that were tested,the ?2-microglobulin(?2-MG)of 43.8%cases was higher(?5.5mg/L).Of the 353 patients that were tested,lactic dehydrogenase(LDH)of 21.2%cases was higher(>230U/L).Of the 374 patients that were tested,17.6%cases were diagnosed with renal insufficiency(creatinin?177umol/L).Of the 360 patients that was tested,11.4%cases were diagnosed with hypercalcemia(>2.75mmol/L).Of the 143 patients that were tested,88.1%cases appeared bone damage.Of the 84 patients that was tested by fluorescence in situ hybridization(FISH),the abnormal genes of IGH,1q21,D13S319,RB1,P53 appeared in 29 case(34.5%),23 cases(27.4%),23 cases(27.4%),27 cases(32.1%),1 5 cases(17.9%)respectively.Of the all the patients,166(44.3%)cases received traditional treatment and 209(55.7%)patients received bortezomib-contained regimens.All the patients received minimal 2-cycles induction therapy,and 51.7%cases received minimal 6-cycles.2.Of 375 NDMM patients,25.9%,14.4%,39.5%,14.9%,5.3%cases achieved complete remission(CR),very good partial remission(VGPR),partial remission(PR),stable disease(SD),progressive disease(PD).The overall response rate(ORR)was 79.7%,with 40.3%achieving?VGPR.The CR,?VGPR and ORR in the group of bortezomib-contained regimens were higher significantly than the group of traditional treatment(34.4%VS 15.1%,P=0.000;49.3%VS 28.9%,P=0.000;86.6%VS 71.1%,P=0.000).In different gender stratification,the CR,?VGPR and ORR in the group of bortezomib-contained regimens were better significantly than the group of traditional treatment(P=0.000,P=0.000,P=0.027)in the male patients.In the female cases,the ORR in the group of bortezomib-contained regimens was higher significantly than the group of traditional treatment(P=0.001).In different age stratification,the CR,?VGPR and ORR in the group of bortezomib-contained regimens were higher significantly than the group of traditional treatment(P=0.000,P=0.000,P=0.002)in the patients aged<65 years.In the cases aged?65 years,the ORR in the group of bortezomib-contained regimens was higher obviously than the group of traditional treatment(P=0.035).In ISS,the CR,?VGPR and ORR in the group of bortezomib-contained regimens were higher significantly than the group of traditional treatment(P=0.000,P=0.006,P=0.000)in the patients staging ?/?.In the cases staging ?,the?VGPR in the group of bortezomib-contained regimens was higher distinctly than the group of traditional treatment(P=0.011).In different renal function,the CR,?VGPR and ORR in the group of bortezomib-contained regimens were higher significantly than the group of traditional treatment(P=0.000,P=0.001,P=0.001)in the patients with normal renal function.In the cases with renal insufficiency,the>VGPR in the group of bortezomib-contained regimens were higher obviously than the group of traditional treatment(P=0.008).The median OS of patients achieving CR/VGPR/PR/<PR was not reached/66/48/24 months,and patients with better efficacy could prolong OS(P=0.000).The patients who received bortezomib-contained regimens demonstrated a better OS compared those who received traditional treatment(P=0.006),especially in the cases who was female,aged<65 years,staged ?/? and with normal function(P=0.030,P=0.011,P=0.001,P=0.002).3.The clinical parameters affecting progression free survival(PFS)by univariate were platelet,serum albumin,ISS,treatment regimens,treatment efficacy,treatment cycles,and stem cell transplantation.The clinical parameters affecting overall survival(OS)by univariate were age stratification,platelet,?2-microglobin,LDH,serum calcium,bone marrow plasma cells,ISS,treatment regimens,treatment efficacy,treatment cycles,stem cell transplantation.On multivariate analyses platelet(HR=0.690,P=0.049),ISS(HR=1.305,P=0.047),treatment regimens(HR=0.536,P=0.000),treatment cycles(HR=0.736,P=0.026),treatment efficacy(HR=0.417,P=0.000)were identified as significant prognostic factors for PFS.Age stratification(HR=1.621,P=0.026),platelet(HR=0.517,P=0.029),?2-MG(HR=0.093,P=0.025),ISS(HR=14.527,P=0.011),treatment efficacy(HR=0.481,P=0.008)were all independent factors affecting OS in NDMM patients.ConclusionThe median age of 375 NDMM patients was 57 years lower than western countries.The male to female ratio of cases was 1.26:1,and the number of annual patients was increasing recently.Bone disease,anemia,renal insufficiency and calcium elevation were the mainly synptoms of NDMM.IgG was the most common monoclonal protein.Stages ? was the most in ISS at the diagnosis.The patients who received bortezomib-contained regimens demonstrated a better efficacy compared with those who received traditional treatment,and prolonged the OS signifantly especially in the cases who was female,aged<65 years,staged ?/?and with normal function.Platelet,treatment regimens,treatment efficacy,treatment cycles were independent factors affecting PFS in NDMM patients.Age stratification,platelet,?2-MG,ISS,treatment efficacy were all independent factors affecting OS in NDMM patients. |
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