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Objective:To investigate the expression level of Ki-67 in the bone marrow biopsy of newly diagnosed MM patients, and its relationship with clinical efficacy and prognosis.Methods:Bone marrow pathological samples of 124 newly diagnosed MM patients in Jiangsu Province Hospital from January 2012 to June 2017 were collected. The expression level of Ki-67 in myeloma cells was detected by using immunohistochemistry. X-tile software was applied to find a cutoff of Ki-67. The patients were divided into the high Ki-67 expression group and the low Ki-67 expression group, and the clinical characteristics, therapeutic efficacy and survival of both groups were compared. Chi-square test or Fisher's exact test was used to analyze the counting data. Kaplan-Meier method was applied to make survival anlaysis. Cox regression model was used for univariate prognostic analysis and multivariate prognostic analysis.Results:A total of 124 newly diagnosed MM patients were enrolled with median follow-up of 36 months. The proportion of the positive myeloma cells in abnormal plasmocytes was used to quantize the expression level of Ki-67. Using a cutoff of 20%, these cases could be divided into two groups; the proportion of positive cells was lower than 20% (the low Ki-67 expression group) and the proportion of positive cells was 20% or above (the high Ki-67 expression group). There were 27 cases (21.7%) in the high expression group and 97 cases (78.2%) in the low expression group. There were no statistically significant differences in the clinical characteristics and treatment regimens (all P > 0.05). The overall remission rate (ORR) of patients in the high Ki-67 expression group was lower than that of patients in the low Ki-67 expression group [59.3% (16/27) vs. 83.5% (81/97)], and the difference was statistically significant (χ 2 = 7.290, P = 0.007). The percentage of patients who achieved very good partial remission (VGPR) and complete remission in the high Ki-67 expression group was lower than that of those in the low Ki-67 expression group [33.3% (9/27) vs. 66.0% (64/97)], and the difference was statistically significant (χ 2 = 9.297, P = 0.002). There were statistically significant differences in the median progression free survival (PFS) time (12.0 months vs. 31.0 months, P < 0.01) and 3-year PFS rate (10% vs. 37%, P = 0.002). The median overall survival (OS) time was 39.0 months and 56.5 months in the high and low Ki-67 expression groups, respectively ( P = 0.003). The multivariate analysis showed that high Ki-67 expression was an independent affecting factor for PFS ( HR = 3.592, 95% CI 1.921-6.719, P < 0.01) and OS ( HR = 3.511, 95% CI 1.537-8.022, P = 0.003). Conclusions:High expression of Ki-67 is an independent poor prognostic factor affecting therapeutic effect and survival for newly diagnosed MM patients.
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OBJECTIVE@#To detect chromosomal aberrations by using cytoplasmic light chain immunofluorescence with fluorescence in situ hybridization (cIg-FISH), and to explore the correlation of del(17p13) with clinical characteristics, drug response and prognosis among patients with newly diagnosed multiple myeloma (NDMM).@*METHODS@#Clinical data of 198 cases of NDMM was collected. cIg-FISH and a specific probe (TP53) were used to detect karyotypic abnormalities in bone marrow samples derived from the patients. Correlation between karyotypic abnormalities and clinical data was analyzed.@*RESULTS@#Nineteen of the 198 patients (9.6%) were found to have a karyotype involving del(17p13). The overall survival (OS) and progression-free survival (PFS) for patients with or without del(17p13) was significantly different (P<0.01). No significant difference was found in OS and PFS between patients carrying a del(17p13) on bortezomib and non-bortezomib regimen (OS: P = 0.873; PFS: P = 0.610).@*CONCLUSION@#cIg-FISH is a simple and convenient method for the detection of karyotypic anomalies in multiple myeloma. Del(17p13) is an indicator for poor prognosis for multiple myeloma patients. Bortezomib cannot improve the survival disadvantage of del(17p13).
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Objective@#To evaluate efficacy of the BiRd regimen, a combination of clarithromycin, lenalidomide, and dexamethasone, in the treatment of patients with relapsed/refractory multiple myeloma (RRMM) .@*Methods@#Patients with RRMM treated with BiRd between September 11, 2013 and August 1, 2016 at six centers were included to evaluate overall survival rate (ORR) , clinical benefit rate (CBR) , progression-free survival (PFS) , overall survival (OS) , as well as adverse events.@*Results@#Of 30 patients with RRMM, 27 patients were evaluable, and ORR and CBR were 51.9% (14/27) and 66.7% (18/27) respectively, including 1 sCR (3.7%) , 3 CR (11.1%) , 3 VGPR (11.1%) , and 7 PR (25.6%) . In 13 patients with prior Rd, ORR and CBR were 38.5% (5/13) and 61.5% (8/13) respectively, of which 5 patients with ≥MR carried high-risk cytogenetic[ (e.g.17p- or t (4;14) ] together with at least one of other adverse-prognostic cytogenetic (e.g.13q- and/or 1q21+) . In 24 patients with prior bortezomib-based therapy, ORR and CBR were 45.8 and 62.5%, respectively. With a median follow-up time of 14.9 (range 1.0-33.8) months, the median PFS and OS were 12.0 (95%CI 11.6-12.4) and 27.6 (95%CI 15.1-40.1) months, respectively. The BiRd regimen was well tolerated.@*Conclusion@#The BiRd regimen is an effective and safety protocol for RRMM, including those carrying high-risk cytogenetic markers.
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Objective@#To observe the efficacy and safety of CTD (cyclophosphamide, thalidomide, dexamethasone) and PCD (bortezomib, cyclophosphamide, dexamethasone) regimens in treatment of patients with newly diagnosed multiple myeloma (NDMM) .@*Methods@#A retrospective analysis was carried out on 88 cases of NDMM patients admitted to our hospital from July 2013 to January 2016, including 49 cases in CTD group and 39 cases in PCD group. The outcomes of two different regimens were analyzed, including response, prognosis, and adverse events.@*Results@#The total overall remission rates (ORR, better than PR) of CTD and PCD were 65.3% (32/49) and 84.6% (33/39) , while very good partial response (VGPR) were 30.6% (15/49) and 53.8% (21/39) , and differences were statistically significant (P=0.041, P=0.028) . The median follow-up was 11.5 (3-33) months. The median progression-free survival (PFS) was (23.0±4.5) months in CTD groups, but it was not achieved in PCD group, with statistically significant differences (P=0.050) . Medial overall survival was not achieved in both two groups, without statistically significant difference (P=0.257) . There were statistical differences between patients with minor response (MR) and patients without MR in medium OS in CTD group (P=0.005) , and there were statistical difference between patients with VGPR and without VGPR in medium OS in CTD group (P=0.042) . Infection was a common adverse event in two groups. The incidences of peripheral neuropathy and herpes zoster were markedly higher in PCD group than CTD group, and the incidences of thrombus, palpation and rash, etc., were higher in CTD group.@*Conclusion@#Both CTD and PCD regimens were effective first-line induction chemotherapy choice for NDMM. PCD regimen is better than CTD in treatment power and deep remission.