摘要
Abstract
Objective To analyze the clinical characteristics and prognostic factors of patients with double hit multiple myeloma(MM)patients with p53 deletion/mutation.Methods MM patients admitted to Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from June 2017 to June 2023 were selected as the study subjects.They used fluorescence in situ hybridization(FISH)to detect chromosomal changes and gene sequencing to detect p53 gene mutations.According to the detection results,a total of 180 patients with p53 deletion/mutation were selected,and these 180 patients were divided into a p53 deletion/mutation-only group(control group,n=73)and a dual strike group with p53 deletion/mutation(research group,n=107).Compared the clinical characteristics and efficacy of two groups of patients,and analyzed the factors influencing the prognosis of MM patients.Established a risk-scoring model for evaluating and validating the prognosis of MM patients.Results The proportion of patients with extramedullary lesions(46.73%),bone lesions(42.06%),DS stage III(70.09%),ISS stage III(64.49%)and R-ISS stage III(59.81%)in research group with p53 deletion/mutation was significantly higher than that in conctrol group(28.77%,19.18%,45.21%,39.73%,32.88%),and the differences were statistically significant(χ2=5.861～12.600,all P<0.05).The OR of patients in research group with p53 deletion/mutation after treatment was 52.34%,lower than 65.75%in conctrol group.Still,there was no statistically significant difference between the two groups(χ2=3.202,P=0.074).The PFS and OS of MM patients with research group were significantly shorter than those with conctrol group,and the differences were statistically significant(χ2=15.522,16.973,all P＜0.05).Multivariate COX proportional hazards results,bone marrow plasma cell ratio≥30%,β2-MG≥5.5mg/L,PLT<125×109/L,LDH≥240U/L and dual strikes with p53 deletion/mutation were risk factors for PFS rate in MM patients(Wald χ2=2.983～3.942,all P＜0.05).R-ISS stage III,bone marrow plasma cell ratio≥30%,β2-MG≥5.5mg/L,LDH≥240U/L and dual strikes with p53 deletion/mutation were risk factors for OS rate in MM patients(Wald χ2=3.389～3.971,all P＜0.05).Establishing a risk scoring model for evaluating the prognosis of MM patients,and the ROC curve results show that the risk scoring model has good discrimination.The 2-year PFS and OS were shortened sequentially in the low-risk group,medium-risk group and high-risk group,and the differences were statistically significant(F=23.629,17.664,all P<0.05).Conclusion The clinical manifestations of MM patients with double-hit p53 deletion/mutation are mainly extramedullary lesions,bone lesions,DS staging,ISS staging,and R-ISS staging,with stage III being the most common.The double-hit of p53 deletion/mutation and accompanying is an important prognostic factor for MM patients.关键词
p53缺失/突变/双打击/多发性骨髓瘤/临床特征/预后因素Key words
p53 deletion/mutation/double-hit/multiple myeloma/clinical features/prognostic factors分类
临床医学
