文章：

结合修订版IMWG诊断标准对冒烟型多发性骨髓瘤进行风险分层

Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria

原文发布日期：2018-06-12

DOI: 10.1038/s41408-018-0077-4

类型: Article

开放获取: 是

英文摘要：

In 2014, the International Myeloma Working Group reclassified patients with smoldering multiple myeloma (SMM) and bone marrow-plasma cell percentage (BMPC%) ≥ 60%, or serum free light chain ratio (FLCr) ≥ 100 or >1 focal lesion on magnetic resonance imaging as multiple myeloma (MM). Predictors of progression in patients currently classified as SMM are not known. We identified 421 patients with SMM, diagnosed between 2003 and 2015. The median time to progression (TTP) was 57 months (CI, 45–72). BMPC% > 20% [hazard ratio (HR): 2.28 (CI, 1.63–3.20); p < 0.0001]; M-protein > 2g/dL [HR: 1.56 (CI, 1.11–2.20); p = 0.01], and FLCr > 20 [HR: 2.13 (CI, 1.55–2.93); p < 0.0001] independently predicted shorter TTP in multivariate analysis. Age and immunoparesis were not significant. We stratified patients into three groups: low risk (none of the three risk factors; n = 143); intermediate risk (one of the three risk factors; n = 121); and high risk (≥2 of the three risk factors; n = 153). The median TTP for low-, intermediate-, and high-risk groups were 110, 68, and 29 months, respectively (p < 0.0001). BMPC% > 20%, M-protein > 2 g/dL, and FLCr > 20 at diagnosis can be used to risk stratify patients with SMM. Patients with high-risk SMM need close follow-up and are candidates for clinical trials aiming to prevent progression.

摘要翻译： 

2014年，国际骨髓瘤工作组将符合以下条件的冒烟型多发性骨髓瘤（SMM）患者重新划分为多发性骨髓瘤（MM）：骨髓浆细胞百分比（BMPC%）≥60%、血清游离轻链比率（FLCr）≥100、或磁共振成像显示>1处局灶性病变。目前尚不清楚被归类为SMM的患者病情进展的预测因素。我们确定了2003年至2015年间确诊的421例SMM患者。中位进展时间（TTP）为57个月（CI，45-72）。多变量分析显示，BMPC%>20%[风险比（HR）：2.28（CI，1.63-3.20）；p<0.0001]、M蛋白>2g/dL[HR：1.56（CI，1.11-2.20）；p=0.01]和FLCr>20[HR：2.13（CI，1.55-2.93）；p<0.0001]是TTP缩短的独立预测因素。年龄和免疫麻痹不具有显著意义。我们将患者分为三组：低危组（无任一风险因素；n=143）、中危组（具备一个风险因素；n=121）和高危组（具备≥两个风险因素；n=153）。低危、中危和高危组的中位TTP分别为110个月、68个月和29个月（p<0.0001）。诊断时BMPC%>20%、M蛋白>2g/dL和FLCr>20可用于SMM患者的风险分层。高危SMM患者需要密切随访，并且是旨在预防疾病进展的临床试验的候选对象。

原文链接：

Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria