Analysis Of Clinical Features And Prognoses Of 169 Patients With Newly Diagnosed Multiple Myeloma

ObjectiveTo discuss the clinical characteristics of multiple myeloma(MM)and analyze the prognostic factors affecting MM,as to provide a basis for the diagnosis and treatment of the disease,by analysising all clinical data collected from newly diagnosed MM patients retrospectively.Materials and methodsIn this study,we retrospectively analyzed 169 patients with newly diagnosed MM enrolled in Fujian Medical University Union Hospital form January 1,2015 to December 31,2018.All the data,including patient’s age,gender,physical state(ECOG score),immunophenotype,D-S stage,ISS stage and R-ISS stage,hemoglobin,serum calcium,serum albumin(propagated),lactate dehydrogenase(LDH),beta 2 microglobulin(β2-MG),creatinine and soluble bone lension and treatment scheme were collected;Abnormal cytogenetics were detected by fluorescence in situ hybridization(FISH)assay for each patient;The cut-off value of lymphocyte count/monocyte count(LMR)was determined by the ROC curve assay;Survival analysis was performed by Kaplan-meier method.Log-rank test and COX proportional risk model were used for prognostic univariate analysis and multivariate analysis respectively.Results169 MM patients including 116 males and 53 females.The median age was 62 years old(range: 31-81),therein 56 cases(33.14%)aged 60-70 years old and42 cases(24.85%)aged 50-60 years old.The most common type was IgG type which was found in 90 cases(53%),followed by IgA type with 46 cases(27%),and non-secretory type with 3 cases(2%).There are 108 cases of abnormal cytogenetics,the overall detection rate was 63.9%(108/169).The cutoff value of LMR was calculated as 3.85 by ROC curve.We have found that D-S stage(P =0.038),ISS stage(P = 0.001),R-ISS(P = 0.025)stage demonstrated a statistically significant of the prognosis of patients with MM by survival analysis;Age,Alb,β2-MG,bone lension,LMR,1q21 gain,and del(17p)were correlated with prognosis by univariate analysis(all P< 0.05).There were 115patients(68.05%)treated with bortezomib and 54 patients(31.95%)treated without bortezomib.A total of 21(12.43%)MM patients underwent autologous hematopoietic stem cell transplantation(ASCT),all of which were treated with bortezomib.The median overall survival(OS)of patients treated with bortezomib was 52 months and 36 months without bortezomib respectively and was statistically significant(P=0.007).In the 115 cases of bortezomib treated group,the median OS of MM patients with ASCT was not reached by the last follow-up,while the median OS of MM patients without ASCT was 52 months and was statistically significant(P=0.039).Age≥65,LMR<3.85,bortezomib free treatment were independent prognostic factors for newly diagnosed MM patients(all P< 0.05)by multivariate analysis.For those patients with LMR < 3.85 and age < 65,the OS in bortezomib treated group was longer than that in bortezomib untreated group(P<0.05).ConclusionsMM mostly occurs in middle-aged and elderly patients with male dominance.The most common type of MM is IgG type.LMR < 3.85 is a poor prognostic factor in newly diagnosed MM patients,which can be used as a new indicator to assess the prognosis of MM if combined with other prognostic indicators.D-S stage,ISS stage and R-ISS stage could be used as the prognosis evaluation in newly diagnosed MM patients.Age,Alb,β2-MG,bone lension,1q21 gain,and del(17p)were prognostic factors with statistically significant in MM patients.The prognosis of treatment with bortezomib was better than that without bortezomib,and ASCT after inductive treatment with bortezomib could prolong the survival of MM patients.For MM patients with LMR < 3.85 and age < 65 years,bortezomib treatment had a more significant effect on survival than other treatment.