上海交通大学学报（医学版）2025，Vol.45Issue(7)：807-814,8.DOI:10.3969/j.issn.1674-8115.2025.07.001
免疫不全麻痹在新诊断多发性骨髓瘤患者中的动态变化及预后意义
Dynamic changes and prognostic significance of immunoparesis in newly diagnosed multiple myeloma patients
摘要
Abstract
Objective·To detect immunoglobulin(Ig)expression levels in newly diagnosed multiple myeloma(MM)patients before and after induction therapy,and to explore the clinical significance of Ig expression levels and their dynamic changes in relation to treatment efficacy,infection occurrence,and prognosis.Methods·Clinical data from 142 MM patients treated at the Department of Hematology,The First Affiliated Hospital of Soochow University between August 2018 and September 2020 were analyzed.Baseline Ig expression levels and post-induction changes following bortezomib-lenalidomide-dexamethasone(VRD)regimen were assessed.Immunoparesis was defined as uninvolved Igs below the laboratory lower limit of normal.Patients were stratified by immunoparesis severity(mild,moderate,severe,extremely severe).ANOVA,rank-sum tests,and x2 tests were used to analyze correlations with baseline characteristics.The relationship between the improvement in immunoparesis and the induction efficacy,infection occurrence,and prognosis was analyzed based on the dynamic changes in immunoparesis.Results·Normal Igs were severely reduced in newly diagnosed MM patients.Immunoparesis was present in 128 patients(90.1%),with severe or extremely severe immunoparesis accounting for 76.1%.Patients with extensive immunoparesis(all uninvolved Ig levels below the lower normal limit)were more likely to have severe immunoparesis(P<0.05).There were no statistically significant differences in age,gender,presence of severe renal insufficiency,and high-risk cytogenetics among MM patients with different degrees of immunoparesis(P>0.05),but there were statistically significant differences in MM staging(P=0.008)and typing(P=0.010).Most patients with severe immunoparesis were at stage Ⅱ/Ⅲ based on the Revised International Staging System(R-ISS)and were of the IgG type.At diagnosis,the levels of the involved Ig or light chain were negatively correlated with normal Ig levels(P<0.05).Improvement in immunoparesis after induction therapy was positively correlated with treatment response(P=0.006).The infection rate was high(26.8%),but no significant correlation was found between immunoparesis and infection occurrence(P>0.05).After induction therapy,patients showing improvement in immunoparesis had significantly longer progression-free survival(PFS)(median PFS:not reached vs 38 months,P=0.025),but no significant impact on overall survival(OS)was observed(P=0.450).Conclusion·Immunoparesis is common and severe in newly diagnosed MM patients,with severity correlating with disease stage and subtype.VRD therapy can partially reverse immunoparesis,and improvement is positively associated with treatment response and PFS benefit.Infection risk appears unrelated to immunoparesis severity and warrants comprehensive prevention strategies.Humoral immune deficiency may serve as a prognostic indicator in MM,but its impact on OS requires further investigation.关键词
多发性骨髓瘤/免疫球蛋白/体液免疫/免疫不全麻痹/感染/预后Key words
multiple myeloma/immunoglobulin/humoral immunity/immunoparesis/infection/prognosis分类
医药卫生引用本文复制引用
严治,吴星玥,姚卫芹,颜灵芝,金松,商京晶,施晓兰,吴德沛,傅琤琤..免疫不全麻痹在新诊断多发性骨髓瘤患者中的动态变化及预后意义[J].上海交通大学学报（医学版）,2025,45(7):807-814,8.基金项目
国家自然科学基金(82270210) （82270210）
苏州市基础研究试点项目(SSD2024088). National Natural Science Foundation of China(82270210) （SSD2024088）
Suzhou Basic Research Pilot Project Project(SSD2024088). （SSD2024088）
