| Objective:To observe the clinical manifestations,response to treatment and prognostic factors of patients with Light-chain type multiple myeloma.Methods:A total of 553 patients with multiple myeloma were newly diagnosed in Qilu Hospital of Shandong University from June 1,2015 to June 31,2020,among which 101 patients with light-chain type multiple myeloma(18.44%)were diagnosed.All the diagnoses met the diagnostic criteria of the IMWG in 2016.Clinical staging was conducted according to the DS staging and the ISS staging.The clinical features,laboratory test,flow cytometry,cytogenetics and response to different treatment regimens and prognsis of 101 patients with light-chain type MM were retrospectively analyzed.All data were analyzed by SPSS 22.0.Clinical feature data were represented by number of cases(percentage)and median,and laboratory examination was represented by X±SD and median,and flow cytometry and FISH were expressed by cases(percentage).Kaplan-Meier method was used to evaluate OS and PFS for different treatment regiments,and log-rank test was used to conduct univariate analysis for observation indicators.P<0.05 was considered statistically significant.Results:1.The ratio of male to female was 1.15:1,and the median age was 63 years(27-84 years).The rates of κ and λ type were 6%(45/101),4%(56/101),respectively.According to DS criteria,among 101 patients with light-chain type MM,the rates of stage Ⅰ、stage Ⅱ and stage Ⅲ were 19.8%(20/101),16.9%(17/101)63.3%(64/101),respectively,5%(54/101)in group A and 46.5%(47/101)in group B.According to ISS staging criteria,among 93 patients with light-chain type MM the rates of stageⅠ、stage Ⅱ and stage Ⅲ were 19.8%(20/93),13.9%(14/93)and 58.4%(59/93),respectively.The main clinical symptoms of 101 patients with light-chain type MM were bone pain,anemia,renal function damage,infection and so on.Bone pain was 58.4%(59/101),anemia was 42.6%(43/101),renal insufficiency was 34.7%(35/101),and infection was 22.8%(23/101).Among the 101 cases of light-chain type MM,leucopenia was 10.89%(11/101),anemia was 50.5%(51/101),thrombocytopenia was 15.84%(16/101),of which moderate anemia(60g/L～89g/L)was 66.67%,severe anemia(30g/L～59g/L)was 15.69%,and one case of platelet was less than 30*10^9/L,with bleeding tendency.Hypoalbuminemia(albumin<35 g/L)was 10.9%(11/101),high β2MG(≥3.5 mg/L)was 72.3%(73/101),of which β 2MG≥5.5 mg/L was 57.4%(58/101),high LDH was 32.7%(33/101),renal insufficiency(creatinine≥177umol/L)was 53.5%(54/101),hypercalcemia was 23.8%(24/101),respectively.The proportion of plasma cells in bone marrow cytology was less than 10%in 28.7%(29/101),10%-30%in 32.7%(33/101),and more than 30%in 38.6%(39/101).Bone marrow biopsy showed plasma cell myeloma in 82.5%(52/63)and no in 17.5%(11/63).Flow cytometry was tested in 49 patients.The positive rates of CD38,CD138,CD56,CD117 and CD27 were 5.9%(47/49),95.9%(47/49),57.4%(27/47),51.1%(23/45)and 83.3%(20/24),respectively.Routine karyotype analysis was carried out in 53 patients,of which 84.9%(45/53)had no chromosomal abnormalities,and 15.1%(8/53)had chromosomal abnormalities.The results of FISH showed that 54.1%(33/61)of the 61 patients had cytogenetic abnormalities.The frequencies of IgH translocation,P53 deletion,D13S319 deletion,1q21 amplification,RBI deletion,CDKN2C and CCND1 were27.7%(13/47),13.3%(8/60),34.1%(15/44),34.5%(20/58),33.3%(18/54),12%(3/12)and 66.7%(4/6),respectively,Most of them have multiple cytogenetic abnormalities at the same time.2.80 patients received treatment in Qilu hospital,after more than 4 courses of treatment,the rates of CR,VGPR,PR,PD were 51.25%(41/80),16.25%(13/80),21.25%(17/80),3.75%(3/80),respectively.The ORR was 88.75%.68 patients received bortezomib-based induction therapy.The rates of CR,VGPR,PR were 54.41%(37/68),17.65%(12/68),16.18%(11/68),respectively.The ORR was 72.06%.Among them,6 patients died of severe pulmonary or intestinal infection after less than 2 cycles of treatment.Among the 11 patients who received bortezomib-free treatment,the rates of CR,VGPR,PR were 27.27%(3/11),9.09%(1/11)and 63.6%(7/11),respectively.The 9 patients,who received ASCT,accepted bortezomib-based induction therapy for more than 4 cycles and reached CR before transplantation.After ACST,3 patients received bortezomib and 6 patients received vinalidomide/thalidomide based consolidation therapy.Two patients relapsed in 13.7 months and 14.1 months after ASCT,respectively.3.Univariate analysis showed that thrombocytopenia,CD2 7 negative and deletion of chromosome 13 were associated with OS in light chain MM.Conclusion:The male to female ratio of 101 patients with light chain multiple myeloma was 1.15:1,and the median age was 63 years old.Most of the patients were in stage III at the time of treatment,and the main clinical manifestations were bone pain,anemia,renal function damage,infection,hypercalcemia,etc.The efficacy of bortezomib-based treatment is better than that of bortezomib-free treatment.The survival time of bortezomib-based treatment and ASCT was longer than that of traditional chemotherapy. |
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