Efficacy comparision of thalidomide for 132 cases of newly diagnosed multiple myeloma with or without extramedullary disease / 白血病·淋巴瘤

ABSTRACT

Objective To investigate the clinical efficiency and effects on prognosis of thalidomide for newly diagnosed multiple myeloma (MM) with or without extramedullary disease.Methods The clinical features and prognostic factors were retrospectively analyzed in 132 patients.Analyze the efficiency of thalidomide and its effects on prognosis of MM patients with or without extramedullary disease.Results The median age of 132 patients was 59 years (28-83 years),52 patients (39.4 ％) had extramellulary multiple myeloma (EM),other 80 patients (60.6 ％) were without EM at diagnosis.The estimate overall survival (OS) of patients with EM was 42.5 months,compared with 54.3 months in those without EM,the difference was statistically significant (P =0.004).Patients accepting thalidomide therapy had a longer estimate OS than those without thalidomide therapy (50.7 months vs 41.2 months,P =0.01).For patients with EM,whether take thalidomide or not have no effect on the prognosis,the difference was not statistically significant (39.7 months vs 38.5 months,P =0.491).While for those without EM,the prognosis for patients who take thalidomide was better than that did not take thalidomide (54.6 months vs 41.2 months,P =0.027).Log-rank univariate analysis showed that accompanied with EM (P =0.004),the proportion of plasma cells≥20 ％ (P =0.02),Hb≤110 g/L (P =0.041),β2-MG ≥ 5.5 mg/L (P =0.018) and without thalidomide therapy (P =0.01) were poor prognostic factors.Multivariate analysis with COX model showed extramedullary disease,β2-MG and the proportion of plasma cells were statistically significant (P ＜ 0.05).Conclusion Patients with EM showed aggressive and complicated prognosis.Thalidomide does not improve the prognosis of patients with EM and they may need combination therapy such as bortezomib or autologous hemopoietic stem cell transplantation.