Clinical Comparison And Prognostic Analysis Of Chemother Apy With And Without Bortezomib Regimens For Multiple Myeloma

Objective:To compare the efficacy and survival of patients with multiple myeloma treated with or without bortezomib according to whether the chemotherapy regimen contained bortezomib,and analyze the prognostic factors.Method:From January 2010 to July 2019,122 MM patients who were newly diagnosed with multiple myeloma?MM?and completed more than two cycles of chemotherapy in the Department of Hematology,the First Affiliated Hospital of Xxx Medical University were retrospectively analyzed.All MM patients who met the inclusion criteria were divided into bortezomib group?bortezomib was used for all chemotherapy regimens?,non-bortezomib group?bortezomib was not used for all chemotherapy regimens?,and change regimen group?traditional chemotherapy regimen and bortezomib containing chemotherapy regimen were used successively during chemotherapy?.The changes of relevant indicators such as hemoglobin?Hb?,erythrocyte sedimentation rate?ESR?,globulin?Glb?,albumin?Alb?,serum creatinine?Cre?,C-reactive protein?CRP?,lactate dehydrogenase?LDH?,alkaline phosphatase?ALP?,erythrocyte calcium?Ca?,blood light chain,?2-microglobulin??2-MG?,immunofixation electrophoresis,bone marrow cytology,chromosome,flow cytometry and other relevant indicators before treatment and after every two courses of chemotherapy?after two and four cycles of chemotherapy?were observed and analyzed,and the efficacy of chemotherapy group with or without bortezomib was evaluated according to the changes of appeal indicators.The survival data of patients in different groups were obtained during follow-up,and the corresponding survival analysis was performed.Finally,the prognostic factors were analyzed according to the appeal indicators at the time of initial diagnosis and after chemotherapy.Result:1.According to the clinical data of 122 patients,the median age was 62 years old,in which the high incidence age was 55-65 years,accounting for 44.3%,followed by 65-75 years,accounting for 31.9%.According to the characteristics of typing,the number of Ig G type patients was 68,accounting for 59%of the total.According to the stage of initial diagnosis,the disease stage of most patients is late.67%of the patients are diagnosed as DS stage III,and 60%are ISS stage III.2.There was no significant difference in the general clinical data?age,gender,ISS stage,DS stage and group?and the hemoglobin,creatinine,blood calcium,globulin,lactate dehydrogenase,albumin,alkaline phosphatase,C-reactive protein,ESR,?₂-microglobulin and blood light chain in the three groups?P>0.05?.3.There was a significant difference in the survival time between the bortezomib group and the non-bortezomib group?P=0.02?,and there was also a significant difference in the survival time between the change scheme group and the non-bortezomib group?P=0.005?,but there was no significant difference between the change scheme group and the bortezomib group?P=0.528?.The survival time of patients in bortezomib group and change scheme group was longer than that in non-bortezomib group.4.The difference in the efficacy of the three groups was statistically significant??2=6.166,P=0.046?,and the difference in the rate of good response among the three groups was also statistically significant??2=10.59,P=0.005?.The distribution of efficacy and good response in the bortezomib group were better than those in the non-bortezomib group during two cycles of chemotherapy?P<0.05?.The efficacy distribution and response of the modified regimen group and the bortezomib group were better than those of the non-bortezomib group at four cycles of chemotherapy?P<0.05?.5.In the chemotherapy with bortezomib group,the changes of hemoglobin,albumin,globulin,lactate dehydrogenase,alkaline phosphatase,serum calcium,ESR,blood light chain?and blood light chain?were statistically significant?P<0.05?.Hemoglobin,albumin and LDH increased gradually,while globulin,ESR,light chain kappa and light chain?decreased gradually.ALP increased in two cycles of chemotherapy,but decreased in four cycles.After two cycles of chemotherapy,serum calcium decreased compared with that before treatment,but began to increase in four weeks of chemotherapy.6.In the chemotherapy without bortezomib group,the changes of hemoglobin,creatinine,globulin and alkaline phosphatase in different chemotherapy cycles were statistically significant?P<0.05?.Hemoglobin increased with the increase of treatment cycle,while globulin and creatinine decreased with the increase of treatment cycle.ALP increased in the two cycles of chemotherapy,but decreased in the four weeks of chemotherapy.7.Kaplan Meier method was used to screen out the factors influencing the survival and prognosis.Lactate dehydrogenase,blood calcium,bone marrow plasma cell ratio,flow cytometry results,complex karyotype,DS grouping,DS staging and treatment methods were the risk factors for survival and prognosis?P<0.05?.All these factors were included in Cox proportional risk regression analysis.The results suggested that treatment methods,bone marrow plasma cell ratio,flow cytometry results?P<0.05?were the risk factors for survival.Conclusion:Consistent with the results of a large number of literature studies,the survival of patients treated with bortezomib based chemotherapy regimens was significantly prolonged.Chemotherapy regimens containing bortezomib were more effective than those without bortezomib.From the analysis of laboratory parameters,the bortezomib group was able to improve more indicators,and it was more appropriate to evaluate the efficacy of chemotherapy after four cycles of chemotherapy based on the results of this study.Before treatment,treatment methods,bone marrow plasma cell ratio,and flow cytometry results are risk factors for survival,and a large number of clinical studies are needed to guide individualized treatment.This study shows that lactate dehydrogenase,erythrocyte sedimentation rate and the proportion of myeloma plasma cells after treatment may be prognostic factors,but it still needs to be confirmed by a large number of clinical data.