Analysis Of Clinical Features And Prognostic Factors Of Multiple Myeloma

Objective:Multiple myeloma（MM）arises from B lymphocytes that is characterized by clonal proliferation of malignant plasma cells in bone marrow.Malignant plasma cells secrete nonfunctional immunoglobulin and immunoglobulin light chain,which cause related organ dysfunction.With further research and the application of novel drugs,overall survival of patients has been significantly increased.This study is aim to investigate the clinical features and prognostic factors of MM patients.Materials and Methods:A retrospective analysis method was used in this study.Clinical data collected from 86 eligible MM patients who were admitted to Quanzhou First Hospital from March 2014 to December 2019.86 MM patients were selected as study subjects,while 50 healthy physical examinees served as control.Firstly,analyzed the clinical characteristics of 86 MM patients including gender,age,stage,type,blood routine+CRP,albumin,globulin,renal function indicators,β₂-microglobulin,tumor cell ratio,imaging and FISH.Secondly,NLR,ANC and ALC between these two group were compared.NLR is the ratio of ANC to ALC;The MM patients were divided into low NLR group and high NLR group according to the mean value,and then the differences of clinical features between them were analyzed.Finally,the Kaplan-Meier method and Log-rank method were used for survival analysis,and the Cox proportional hazard regression model was used to analyze the risk factors.Results:1.（1）The median age of MM patients is 65 years old,and the age range is30-85 years old;the ratio of male to female is 1.39:1;The most common first symptoms were bone pain and symptoms of anemia;IgG type accounts for 49.1%（42/86）,and IgA type 26.7%（23/86）;ISS stage III accounts for 50%（43/86）;Hb<85g/L accounts for 59.3%（51/86）;CRP>8mg/L accounts for 32.6%;Albumin<35g/L accounts for 74.4%（64/86）,serum calcium>2.65mmol/L accounted for10.5%（9/86）,serum calcium increased after correction accounted for 22.1%（19/86）;β₂-MG>5.5mg/L accounted for 50%（43/86）;LDH>245U/L accounted for18.5%（16/86）;Cr>177μmol/L accounted for 19.7%（17/86）;tumor cells>10%accounted for 81.4%（70/86）;Bone damage accounted for 77.6%（66/86）;（2）Genetic abnormality detected by FISH accounted for 70.9%（22/31）,RB1missing 38.7%（12/31）,D13S319 missing 22.6%（7/31）,IGH rearrangement accounted for 29.0%（9/31）,P53 gene deletion accounted for 9.7%（3/31）,and1q21 amplification accounted for 48.4%（15/31）.2.Single factor analysis showed risk factors for MM’s poor prognosis were as follows:corrected serum calcium>2.65mmol/L,β₂-MG>5.5mg/L,albumin<35g/L and NLR>2.66.Multiple factors analysis showed that independent risk factors were as follows:albumin<35g/L,corrected serum calcium>2.65 mmol/L,and NLR>2.66（P<0.05）.3.Comparison of NLR between MM group and control group:NLR（2.66±2.02 vs 1.87±0.60 P=0.001）and ALC（1.957±0.52 vs 1.56±0.73 p<0.0001）.There were statistically significant differences between the low-level NLR and high-level NLR including corrected serum calcium,immunophenotyping,ISS staging,urea,globulin,β₂-MG,PFS,and OS（P<0.05）,and was no significant difference in gender,age,Hb,CRP,LDH,ALB,uric acid,creatinine,and the proportion of tumor cells（all P>0.05）;Median PFS and OS between them were significant differences,PFS was 29.6 months（95%CI 23.5～35.7）in high-level NLR group and 22.3 months（95%CI 15.4-29.2）in low-level NLR group（P=0.01）,respectively,while median OS was respectively 47.0 months（95%CI 30.5-63.5）and 26 months（95%CI 22.2-30.4）（P=0.007）.Conclusion:·Multiple myeloma occurs more frequently in elderly men than in women;bone pain and anemia were the most common symptoms at the first diagnosis;IgG and IgA were the most common subtypes,and ISS stage III is the majority;most MM patients were complicated with moderate to severe anemia,decreased albumin,increasedβ₂-MG,increased proportion of tumor cells and bone damage;abnormal serum calcium,LDH,Cr and CRP were rare.RB1 deletion and IgH rearrangement were common in FISH.·Serum calcium（corrected）,β₂-MG,albumin and NLR were risk factors for poor prognosis of MM,and serum calcium,albumin and NLR were independent risk factors.·Newly diagnosed MM patients were found decreased ALC and increased NLR.MM patients with high level of NLR have shorter progression free survival and overall survival,and poor prognosis.