Multivariate Analysis Of Prognosis In Patients With Multiple Myeloma

Objective:1.To investigate the effect of different treatment options on the curative effect and prognosis of multiple myeloma(MM)patients;2.to explore the relationship between the absolute value of peripheral blood lymphocytes and neutrophil/lymphocyte ratio and the prognosis of patients with multiple myeloma.Methods:We retrospectively analyzed data from de novo patients with MM in our hospital from January 2013 to June 2017.According to ALC?NLR,all MM patients were divided in to high ALC group(ALC?1.57�10~9/L)?low ALC group(ALC<1.57�10~9/L),high NLR group(NLR?2.4)?low NLR group(NLR<2.4).They all recieved at least 3 courses of treatments.We assess their clinical therapeutic effect with IMWG standard,following up for 6 months at least.We analysed the correlation of ALC and NLR levels in de novo MM patients with Age?gender?DS stage?ISS stage?serum calcium?hemoglobin?creatinine?efficacy??2-Mg?LDH?albumin levels and efficacy?prognosis.Results:1.Totally 105 multiple myeloma patients were analysed,58 were male and 47were female.The age of diagnosis was 38 to 81 years old and the median age was 58years.Among them,50-60 years old accounted for 39.05%,and 60-70 years old accounted for 33.33%.2.According to M protein classification,there were 50 cases(47.6%)of IgG type,followed by 35 cases(33.3%)of type IgA,15 cases(14.3%)of light chain type,and 5 cases(4.8%)of IgD.3.According to DS stage,the patients with stage III were76 cases(72.4%).There were 14 patients(13.3%)and 15 patients(14.3%)in stage I and II patients,respectively.There were 20 cases(19.0%),37 cases(35.2%)and 48 cases(45.7%)in ISS stage I,II,and III MM patients.4.105 cases of MM patients,including 64 cases of effective MM patients,the effective rate was 70.9%.A total of 41 patients were included in bortezomib-based group,of which 32 patients(78%)were effective.In non-bortezomib-based group,there were 64,of which 32 patients(50%)were effective.The overall response rate of bortezomib-based group was better than that of non-bortezomib-based group(P<0.05).K-M analysis showed that the overall survival of bortezomib-based group was significantly better than that of non-bortezomib-based group.5.According to the level of NLR in patients with newly diagnosed MM,they were divided into high NLR group(NLR?2.4)and low NLR group(NLR<2.4).There were 72 cases in the high NLR group and 33 cases in the low NLR group.MM patients in low NLR group mostly occurred in hyperalbuminemia(?35g/l),and high hemoglobin Level(?85g/l),hypocalcemia patients(<2.6mmol/l);However,no matter whether the total effective rate,the non-bortezomib-based group or the bortezomib-based group,there was no significant difference in the treatment efficiency between the low NLR group and the high NLR group(all P>0.05)6.According to the ALC value of MM patients at the time of initial diagnosis,they were divided into high ALC group(ALC?1.57�10~9/L)and low ALC group(ALC<1.57�10~9/L).There were 60 patients with high ALC and 45 patients with low ALC.MM in high-ALC group mostly occurred in ISS stage I/II stage,hypocalcemia patients(<2.6mmol/l),hyperalbuminemia patients(?35g/l)(P<0.05).In efficacy set,ALC?NLR seemed to have no statistically significant(P=0.564?P=0.214).K-M analysis showed that the overall survival time in the low-ALC group was significantly shorter than that in the high-ALC group(P<0.05).The overall survival time in the low-ALC group was significantly longer than that in the high-ALC group(P<0.05).However,no matter whether the total effective rate,the non-bortezomib-based group or the bortezomib-based group,there was no significant difference in the treatment efficiency between the low ALC group and the high ALC group(all P>0.05).7.Multivariate analysis showed that NLR?2.4?LDH?190u/l were independent prognostic factors in MM patients.Conclusion:1.bortezomib-based chemotherapy can significantly improve the efficacy of multiple myeloma patients and prolong their overall survival.2.High-ALC group(ALC?1.57�10~9/L)and low-NLR group(NLR<2.4)at the time of initial admission could indicate long overall survival of MM patients and was associated with multiple MM independent prognostic factors.3.Multivariate analysis showed that NLR?LDH was an independent prognostic factor for MM.