初诊多发性骨髓瘤患者高危细胞遗传学异常数目对临床特征及预后的影响

OBJECTIVE: To investigate the influence of the number of high-risk cytogenetic abnormalities（HRCA）on the clinical characteristics and prognosis of patients with newly diagnosed multiple myeloma（MM）. METHODS: A total of 360 patients with newly diagnosed MM admitted to Jiangsu Province Hospital between November 2013 and September 2020 were included in this study. Cytoplasmic light chain immunofluorescence with fluorescence in situ hybridization（cIg-FISH）was used to detect HRCA. Cytogenetic abnormalities were combined with clinical characteristics and outcomes for further analysis. RESULTS: Among the 360 patients, 120 patients（33.3％）presented with no HRCAs, and 175（48.6％）, 61（16.9％）, and four（1.1％）patients had one, two, and three HRCA（s）, respectively. Patients were divided into three groups, including the no-HRCA group, one-HRCA group, and ≥two-HRCA group, according to the number of HRCAs. There were significant differences in the R-ISS stage, hemoglobin level, albumin level, and the proportion of bone marrow plasma cells among the three groups（P<0.05）. The COX proportional-hazards model identified extramedullary disease（P＝0.018）, HRCA ≥ 2（P＝0.001）, and absence of autologous hematopoietic stem cell transplantation（P<0.001）as independent risk factors for progression free survival（PFS）and identified lactate dehydrogenase（LDH）level ≥ 220 U/L（P<0.001）, HRCA ≥2（P＝0.001）, and absence of autologous hematopoietic stem cell transplantation（P＝0.005）as independent risk factors for overall survival（OS）. The median PFS was 28 months, 22 months, and 14 months（P＝0.005）for the three cohorts, and their OS was not reached, 60 months, and 30 months（P＝0.001）, respectively. CONCLUSION: HRCA ≥ 2 is an independent risk factor for decreased survival in patients with newly diagnosed MM. More HRCAs result in heavier tumor burden, as well as a higher risk of disease progression and death.