Evolving changes in disease biomarkers and risk of early progression in smoldering multiple myeloma
Evolving changes in disease biomarkers and risk of early progression in smoldering multiple myeloma
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DOI：
10.1038/bcj.2016.65
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发表时间：
2016-07-01
影响因子：
12.8
通讯作者：
Rajkumar, S. V.
中科院分区：
文献类型：
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作者：
Ravi, P.;Kumar, S.;Rajkumar, S. V.
1973年至2014年期间，我们在我们机构研究了190例阴燃多发性骨髓瘤(SMM)患者。单抗蛋白水平(EMP)的演变变化被定义为在诊断的前6个月内血清单抗蛋白(M)和/或免疫球蛋白(M/Ig)增加10%(仅当M-蛋白质和/或免疫球蛋白(M/Ig)=3g/dl时)和/或在前12个月内M/Ig增加25%，M-蛋白和/或Ig至少需要增加0.5g/dl和/或500 mg/dl。血红蛋白(EHb)的演变变化被定义为在确诊后12个月内<0.5g/dl下降。共有134名患者(70.5%)在10.4年的中位随访期内进展为多发性骨髓瘤。在多变量分析中，骨髓浆细胞和Gt；=20%(优势比OR=3.3(1.3~8.77)，P=0.013)、EMP(OR=8.20(3.19~21.05，P<；0.001)和EHb(OR=5.86(2.12~16.21，P=0.001))是MM诊断后2年内进展的独立预测因素。建立了包含这些变量的风险模型，具有0-3个危险因素的患者的中位进展时间分别为12.3年、5.1年、2.0年和1.0年。同时表现为EMP和EHB的患者的2年进展风险为81.5%，同时存在这三种危险因素的患者的2年进展风险为90.5%。
We studied 190 patients with smoldering multiple myeloma (SMM) at our institution between 1973 and 2014. Evolving change in monoclonal protein level (eMP) was defined as >= 10% increase in serum monoclonal protein (M) and/or immunoglobulin (Ig) (M/Ig) within the first 6 months of diagnosis (only if M-protein >= 3 g/dl) and/or >= 25% increase in M/Ig within the first 12 months, with a minimum required increase of 0.5 g/dl in M-protein and/or 500 mg/dl in Ig. Evolving change in hemoglobin (eHb) was defined as >= 0.5 g/dl decrease within 12 months of diagnosis. A total of 134 patients (70.5%) progressed to MM over a median follow-up of 10.4 years. On multivariable analysis adjusting for factors known to predict for progression to MM, bone marrow plasma cells >= 20% (odds ratio (OR) = 3.37 (1.30-8.77), P = 0.013), eMP (OR = 8.20 (3.19-21.05), P < 0.001) and eHb (OR = 5.86 (2.12-16.21), P = 0.001) were independent predictors of progression within 2 years of SMM diagnosis. A risk model comprising these variables was constructed, with median time to progression of 12.3, 5.1, 2.0 and 1.0 years among patients with 0-3 risk factors respectively. The 2-year progression risk was 81.5% in individuals who demonstrated both eMP and eHb, and 90.5% in those with all three risk factors.