| Background Multiple myeloma(MM)is a hematologic malignancy in which plasma cells that synthesize and secrete immunoglobulins undergo malignant transformation,producing large amounts of monoclonal immunoglobulins(M proteins),resulting in multiple organ or tissue damage.MM tends to occur in the middle-aged and the elderly,and tends to be younger.In recent years,the incidence of multiple myeloma has been increasing with the development of population ageing.MM exists obvious Heterogeneity,the patient prognosis difference is obvious,therefore carries on the research positively to explore with the patient prognosis related influence factor and the target,it has important significance in guiding the choice of clinical treatment plan and effectively predicting the prognosis of patients.Objective To analyze the clinical features,including general and cytogenetics changes,and to analyze the risk factors associated with prognosis in MM patients,to provide a practical basis for improving the clinical diagnosis rate,prognosis evaluation and treatment of MM.Methods According to the inclusion and exclusion criteria,137 patients with multiple myeloma were selected from the first people’s Hospital of Changzhou from January 2010 to September 2019.The clinical features,clinical laboratory parameters and cytogenetics changes were analyzed retrospectively,these techniques include karyotype analysis and Fluorescence in situ hybridization(FISH)techniques.Objective:to describe the clinical features of patients and to analyze the relationship between clinical parameters and prognosis by single and multiple factor analysis of survival time(OS),to explore the independent risk factors influencing the prognosis of MM patients.Results 1.General clinical features:1)among the 137 MM patients,there were 75 males and 62 females.The ratio of males to females was 1.2:1.The average age of onset was 65 years,and the peak age was 60-69 years.The most common type of MM was IgG,accounting for 46.7%;2)laboratory examination showed that about 77.4%of MM patients had anemia of different degrees,and the incidence of moderate anemia was the highest(about 41.6%).Most MM patients had normal renal function,and only 13.9%had renal insufficiency;MM patients mostly normal blood calcium,only 19%of patients with hypercalcemia,but more bone destruction,about 73%;most patients with delayed diagnosis,according to the D-S staging and ISS staging,78.1%and 51.1%of MM patients were in Stage III at the time of diagnosis.2.Cytogenetics Analysis:1)karyotype analysis:Most of the patients who underwent karyotype analysis showed normal karyotype,the detection rate of Chromosomal karyotype abnormality was 36.8%;2)FISH:the majority of the patients who received FISH examination were abnormal in different conditions,the total abnormal detection rate was 79.4%,the abnormal detection rate was 36.8%;According to the genetic changes of 17P-,13q-,1q + and IGH rearrangement,33.1%,22.1%,19.1%and 1.5%of 17P-,13q-,1q+and IGH rearrangement occurred simultaneously;3)the detection rate of 13q-abnormality was 8.5%in chromosome karyotype analysis,46.3%in FISH,1.7%in chromosome karyotype analysis and 50%in FISH.3.Analysis of prognostic factors:1)single factor prognostic analysis:Age,ISS stage,creatinine,albumin,hemoglobin,LDH,blood β2-MG,blood calcium,treatment,1q+,13q-,17P-,IGH rearrangement,abnormal karyotype detection,chromosome detection greater than 3 Chromosome abnormality and Chromosomal translocation were the prognostic factors;2)Cox multivariate analysis:Age>65 years old,blood calcium>2.65 mmol/L,traditional drug therapy,chromosome detection more than 3 Chromosome abnormality were independent factors influencing the poor prognosis of MM patients,and the relative risk from high to low was blood calcium,age,treatment,more than 3 Chromosome abnormality.Conclusion 1.The general clinical data show that the proportion of male patients with MM is slightly higher than that of female patients,the onset age is mostly middle and old age,the peak age is 60-69 years old,and the TgG type is the most common.Most patients with MM have anemia and bone destruction of different degrees,only a few patients have renal insufficiency and hypercalcemia,the symptoms of MM patients are not typical,clinical work to deal with anemia,bone destruction,middle-aged and elderly patients with renal impairment and hypercalcemia should be vigilant to avoid misdiagnosis and missed diagnosis.2.Most patients with MM were in Stage Ⅲ when they were diagnosed.3.The results of cytogenetics analysis in MM patients showed that the detection rate of chromosome karyotype abnormality was low(about 36.8%),and the detection rate of FISH was high(about 79.4%),the results indicate that FISH is more sensitive and reliable than traditional chromosome examination.4.Univariate and multivariate analysis of the prognosis of MM patients showed that there were many factors affecting the prognosis of MM patients,age≥65 years,blood calcium≥ 2.65 mmol/L,traditional drug therapy and chromosome detection more than 3 Chromosome abnormality were independent factors of poor prognosis in MM patients,the relative risk of blood calcium was highest. |
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