The Clinical Study Of Multiple Myeloma

â… The incidence and correlation factors of osteopathia in the patients with multiple myelomaObjective To investigate the incidence and correlation factors of osteopathia in the patients with multiple myeloma(MM).Methods Eighty-four MM patients were hospitalized in our department from January 1983 to June 2006 were analyzed retrospectively.Results(1)The overall incidence of osteopathia in MM patients was 83.3%; according to the type of osteopathia,the osteolytic lesion was 60.9%,the pathologic fracture was 32.8%,the osteoporoswas was 80%,the pwerenchyma mass was 6%, and there was statwastical difference between the first two groups(P＜0.05); according to the position of the osteopathia,crinial bone was 58%,costal bone was 42%,both were more frequent than that of the long bone in extremities(20.3%) (P＜0.05):According to Durie-Salmon staging,in order,they were 0%,26%and 38%in three stages;According to the type of M protein in serum,IgG group was 90.6%,IgA group was 86.7%,both light chain group and smoldering group were 100%,and there was no statwastical difference between any two groups;MM patients elder than 50 years were with high risk of suffering osteopathia(89.4%vs 66.7%). No male or female predominance in osteopathia.(2)Tumor burden index associated with MM osteopathia.According to the incidence of osteopathia,The MM patients were divided in four groups.There were statisfical difference of some tumor burden index between the two groups,including serum albumin,β₂ microglobulin,serum globulin,IgG(only IgG group),serum calcium,serum uric acid, plasma cell type.There were also some indexed with no statistical difference between the two group,including serum CRP,serum phosphonium,BUN,Crea,the proportion of plasma cell in bone marrow,the quantity of M protein in IgA and light chain group. (3)Multiplicity.Logistic regression equation suggests that the serum globulin and β₂ microglobulin level were correlated with the incidence of osteopathia,and both of them were risk factors of MM.Conclusion The incidence of osteopathia(83.3%)in MM patients was highly correlated with serumβ₂ microglobulin and globulin level.â…¡The survival time and correlation factors of patients with multiple myelomaObjective To investigate the survival time and correlation factors of patients with multiple myeloma.Methods 107 MM patients were hospitalized in our department from January 1983 to September 2007 were analyzed retrospectively,Results 1.The average survival time of MM patients was 32 months.2.The host factors influencing the survival time of MM patients.According to the age,all patients can be divided into three groups--under 50 years,50-70 years and over 70 years.Respectively,the overall survival time of this three groups were 29.77±5.69 months,42.42±7.28 months and 16.14±3.40 months.Ther was statistical difference (P＜0.05)between the last two groups.3.The correlation factor related to the survival time of MM patients.(1)The complications at diagnoswas,The survival time of MM patients with or without extra-marrow infiltration were 16.32±4.52 months and 32.28±2.96 months respectively(P＜0.05);and that in patients with infection was 29.57±2.83 months,shorter than that in patients without infection (P＜0.05);There was no statistical difference between patients with and without osteopathwas.(2)Laboratory examination.The survival time of patients with normal platelet count(Plt≥100×10⁹/L)was 34.00±3.21 months,longer than the patients with abnormal platelet count(Pit＜100×10⁹/L);the serumβ₂ microglobulin level was correlated with the survival time of MM patients.The patients could be divided into two groups according to theβ₂ microglobulin level above or below 2.9mg/L,the average survival time of the two groups were 27.11±3.60 months and 45.27±5.08 months respectively(P＜0.05);The average survival time of patients with normal uric acid level(35.33±3.51 months)was longer than that of higher uric acid patients(20.36±3.45months)(P＜0.05).(3)Bone marrow examination.The proportion of plasma cell in bone marrow was another correlation factor,here, patients were divided into four groups according to the percentage of plasma cell in bone marrow--＜15%,15%-30%,30%-50%and＞50%.Respectively,the average survival time of this four groups was 32.67±4.82 months,34.94±4.23 months, 30.28±5.87 months,14.73±3.03 months,and the survival time of the fourth group was significantly shorter than the first and the second group(P＜0.05),however,there was no statistical difference between other groups(P＞0.05);the type of plasma cell was also a correlation factor to survival time,which could be divided into another four groups—plasmablast,immature plasma cell,mature cell and mixed plasma cell. The average survival time of this four groups were13.67±5.17 months,9.50±3.09 months,33.33±4.83 months,32.46±3.61 months respectively.The average survival time of the second group was shorter than the third and the fourth group(P＜0.05), there was no statistical difference between other groups(P＞0.05).(4)The influence of treatment to survival time.In patients received chemotherapy with or without M₂ scheme,the average survival time were 31.54±2.97 months and 19.17±5.43 months (P＜0.05)respectively;the survival time of patients received complete remwassion (CR)after treatment(36.03±3.46 months)was longer than others without CR (22.85±4.81 months)(P＜0.05);After one course chemotherapy,the survival time of the patients with CR(44.20±5.90 months)was longer than that of the patients without CR(25.74±3.24 months)(P＜0.05).(5)White blood cell count,hemoglobin level, serum albumin,serum globulin,serum calcium,serum CRP,serum LDH,BUN,Crea, urine protein,urine occult blood,urine Bence Jones protein,Durie-Salmon stage,the number of chemotherapy courses after CR had no relationship with survival.4.Multiplicity.There were several independent prognostic factors had relationship with the survival time of MM patients,including platelet count,serumβ2 microglobulin level,the type of plasma cell in bone marrow and whether CR or not after treatment in Cox regression model.Conclusion 1.The overall survival time of MM patients was 32 months.2.The single factors related to the survival time were age,extra marrow infiltration and infection at diagnosis,platelet count,serumβ₂ microglobulin level,serum uric acid, the proportion and type of plasma cell in bone marrow,whether including M₂ scheme in chemotherapy or not,whether received CR after treatment and whether received CR after one course chemotherapy.3.The multiple factors related to the survival time of MM patients were platelet count,serumβ₂ microglobulin level,the proportion and type of plasma cell in bone marrow and whether received CR after treatment.4.To comprehend the correlation factors related to the survival time of MM patients was good for choosing effective and individualized treatment.Furthermore,according to different individual situations,hierarchy treatment can be displayed for getting better outcome and longer survival time.