累及中枢神经系统多发性骨髓瘤患者的病例对照研究

OBJECTIVE: To investigate the treatment options for multiple myeloma patients with central nervous system involvement（CNS-MM）, as well as their clinical characteristics and prognostic factors. METHODS: Between January 2011 and January 2022 our center diagnosed 18 people with CNS-MM. A retrospective analysis was done on the clinical information from the initial diagnosis and central nervous system involvement, and it was compared to 1∶3 matched newly diagnosed MM from the same period. Analysis was done on the clinical characteristics and survival rates of the two groups. RESULTS: In patients with CNS-MM, the median time of onset was 14.2（0.9–79.6）months and the median overall survival（OS）was 30.5 months from initial diagnosis and only 3.8 months in patients after CNS involvement. The CNS-MM patients showed more IgD type（P＝0.010）, severer anemia（P＝0.014）, a higher proportion of bone marrow plasma cells（P＝0.013）, more extramedullary lesions（P＝0.001）, and increased lactic dehydrogenase（LDH）（P＝0.009）when compared to the control group. Lenalidomide or pomalidomide-based combinations had higher rates of hematology and CNS remission than bortezomib or daratumumab-based regimens（75.0％ vs 16.7％, P＝0.019）. Patients who received IMiD-based regimens and had 2 high-risk factors at initial diagnosis（high LDH and extramedullary lesions）had a significantly lower incidence of CNS-MM（P＝0.026）. At the initial diagnosis, LDH（P＝0.008, HR＝7.319, 95％CI 1.663–32.219）and extramedullary lesions（P＝0.006, HR＝8.054, 95％CI 1.828-35.486）were independent risk factors for the occurrence of CNS-MM. CONCLUSION: Patients with CNS-MM had a poor prognosis. Patients with high LDH or extramedullary lesions at the time of the initial diagnosis are more likely to have CNS-MM. The prognosis of this patient may be improved by immunoregulator-based therapy.