外周血细胞计数及其比值对初诊伴非骨相关髓外病变的多发性骨髓瘤患者预后的评估价值
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摘要
目的探讨外周血淋巴细胞计数(ALC)、单核细胞计数(AMC)、淋巴细胞与单核细胞比值(LMR)、血小板与淋巴细胞比值(PLR)与初诊时伴非骨相关髓外病变(sEMD)的多发性骨髓瘤(MM)患者临床病理特征的相关性以及对疗效和生存的影响。方法收集81例初诊时伴sEMD的MM患者临床病理资料,分别分析外周血ALC、AMC、LMR、PLR与血红蛋白、肌酐水平、乳酸脱氢酶水平、β2微球蛋白水平、治疗疗效、预后生存情况等指标关系。以ALC、AMC、PLR、LMR中位数为界值进行分组。Kaplan-Meier法分析ALC、AMC、PLR、LMR与生存及预后之间的关系;预后多因素分析采用Cox风险回归模型。结果 81例患者ALC、AMC、PLR、LMR中位数分别为1.38×10~9/L、0.48×10~9/L、134.9、3.11,多因素分析结果显示:LMR≤3.11(P=0.021)、PLR≥134.9(P=0.019)、LDH≥247U/L(P=0.041)、Hb≤110 g/L(P=0.004)是初诊伴sEMD的MM患者预后不良的影响因素。结论对于初诊伴sEMD的MM患者,LMR≤3.11、PLR≥134.9、LDH≥247 U/L、Hb≤110 g/L可能是其影响预后不良的独立因素。
Objective To investigate the correlation of peripheral blood lymphocyte count(ALC), monocyte count(AMC), lymphocyte-to-monocyte ratio(LMR), platelet-lymphocyte ratio(PLR) with clinicopathological features of initially-diagnosed multiple myeloma(MM) patients with non-bone-related extramedullary diseases(sEMD), as well as their effect on efficacy and survival. Methods We collected the clinicopathological data of 81 MM patients with sEMD at the initial diagnosis to analyze the relationship of peripheral blood ALC,AMC, LMR, PLR with hemoglobin, creatinine level, lactate dehydrogenase level, β2 microglobulin level,therapeutic efficacy, prognosis survival, etc. The median of ALC, AMC, PLR and LMR were taken as the cutoff value for grouping. Kaplan-Meier method was used to analyze of the relationship of ALC, AMC, PLR,LMR with survival and prognosis. The Cox proportional hazard model was used for multivariate analysis of prognosis. Results The median ALC, AMC, PLR and LMR of the 81 patients were 1.38×10~9/L, 0.48×10~9/L, 134.9 and 3.11, respectively. The multivariate analysis showed that LMR≤3.11(P=0.021), PLR≥134.9(P=0.019), LDH≥247 U/L(P=0.041), and Hb≤110 g/L(P=0.004) were independent predictors of poor prognosis of initially-diagnosed MM patients with sEMD. Conclusion For initially-diagnosed MM patients with sEMD, LMR≤3.11, PLR≥134.9, LDH≥247 U/L and Hb≤110 g/L may be independent factors for the poor prognosis.
Objective To investigate the correlation of peripheral blood lymphocyte count(ALC), monocyte count(AMC), lymphocyte-to-monocyte ratio(LMR), platelet-lymphocyte ratio(PLR) with clinicopathological features of initially-diagnosed multiple myeloma(MM) patients with non-bone-related extramedullary diseases(sEMD), as well as their effect on efficacy and survival. Methods We collected the clinicopathological data of 81 MM patients with sEMD at the initial diagnosis to analyze the relationship of peripheral blood ALC,AMC, LMR, PLR with hemoglobin, creatinine level, lactate dehydrogenase level, β2 microglobulin level,therapeutic efficacy, prognosis survival, etc. The median of ALC, AMC, PLR and LMR were taken as the cutoff value for grouping. Kaplan-Meier method was used to analyze of the relationship of ALC, AMC, PLR,LMR with survival and prognosis. The Cox proportional hazard model was used for multivariate analysis of prognosis. Results The median ALC, AMC, PLR and LMR of the 81 patients were 1.38×10~9/L, 0.48×10~9/L, 134.9 and 3.11, respectively. The multivariate analysis showed that LMR≤3.11(P=0.021), PLR≥134.9(P=0.019), LDH≥247 U/L(P=0.041), and Hb≤110 g/L(P=0.004) were independent predictors of poor prognosis of initially-diagnosed MM patients with sEMD. Conclusion For initially-diagnosed MM patients with sEMD, LMR≤3.11, PLR≥134.9, LDH≥247 U/L and Hb≤110 g/L may be independent factors for the poor prognosis.
引文
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[2]Weinstock M,Aljawai Y,Morgan EA,et al.Incidence and clinical features of extramedullary multiple myeloma in patients who underwent stem cell transplantation[J].Br J Haematol,2015,169(6):851-8.
[3]Lin B,Chen C,Qian Y,et al.Prognostic role of peripheral blood lymphocyte/monocyte ratio at diagnosis in diffuse large B-cell lymphoma:a meta-analysis[J].Leuk Lymphoma,2015,56(9):2563-8.
[4]Chen L,Zhang F,Sheng XG,et al.Decreased pretreatment lymphocyte/monocyte ratio is associated with poor prognosis in stageⅠb1-Ⅱa cervical cancer patients who undergo radical surgery[J].Onco Targets Ther,2015,8:1355-62.
[5]Haruma T,Nakamura K,Nishida T,et al.Pre-treatment neutrophil to lymphocyte ratio is a predictor of prognosis in endometrial cancer[J].Anticancer Res,2015,35(1):337-43.
[6]Porrata LF,Ristow K,Colgan JP,et al.Peripheral blood lymphocyte/monocyte ratio at diagnosis and survival in classical Hodgkin’s lymphoma[J].Haematologica,2012,97(2):262-9.
[7]Rajkumar SV,Dimopoulos MA,Palumbo A,et al.International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma[J].Lancet Oncol,2014,15(12):e538-48.
[8]Gerecke C,Fuhrmann S,Strifler S,et al.The Diagnosis and Treatment of Multiple Myeloma[J].Dtsch Arztebl Int,2016,113(27-28):470-6.
[9]Ma J,Liu S,Wang Y.MicroRNA-21 and multiple myeloma:small molecule and big function[J].Med Oncol,2014,31(8):94.
[10]Bjorklund CC,Baladandayuthapani V,Lin HY,et al.Evidence of a role for CD44 and cell adhesion in mediating resistance to lenalidomide in multiple myeloma:therapeutic implications[J].Leukemia,2014,28(2):373-83.
[11]Highsmith KN,Chen SE,Horowitz S.Carfilzomib and pomalidomide:recent advances in the treatment of multiple myeloma[J].Pharmacotherapy,2014,34(9):927-40.
[12]Le Jeune C,Bertoli S,Elhamri M,et al.Initial absolute lymphocyte count as a prognostic factor for outcome in acute myeloid leukemia[J].Leuk Lymphoma,2014,55(4):855-62.
[13]Yan M,Jurasz P.The role of platelets in the tumor microenvironment:From solid tumors to leukemia[J].Biochim Biophys Acta,2016,1863(3):392-400.
[14]Zhou D,Liang J,Xu LI,et al.Derived neutrophil to lymphocyte ratio predicts prognosis for patients with HBV-associated hepatocellular carcinoma following transarterial chemoembolization[J].Oncol Lett,2016,11(5):2987-94.
[15]Friedman DR,Sibley AB,Owzar K,et al.Relationship of blood monocytes with chronic lymphocytic leukemia aggressiveness and outcomes:a multi-institutional study[J].Am J Hematol,2016,91(7):687-91.
[16]Song YJ,Wang LX,Hong YQ,et al.Lymphocyte to monocyte ratio is associated with response to first-line platinum-based chemotherapy and prognosis of early-stage non-small cell lung cancer patients[J].Tumour Biol,2016,37(4):5285-93.
[17]Li J,Jiang R,Liu WS,et al.A large cohort study reveals the association of elevated peripheral blood lymphocyte-to-monocyte ratio with favorable prognosis in nasopharyngeal carcinoma[J].PLoS One,2013,8(12):e83069.
[18]Lin JP,Lin JX,Cao LL,et al.Preoperative lymphocyte-tomonocyte ratio as a strong predictor of survival and recurrence for gastric cancer after radical-intent surgery[J].Oncotarget,2017,8(45):79234-47.
[19]Kiba T,Ito T,Nakashima T,et al.Bortezomib and dexamethasone for multiple myeloma:higher AST and LDH levels associated with a worse prognosis on overall survival[J].BMC Cancer,2014,14:462.
[20]黄莉,姚红霞.61例继发性噬血细胞综合征临床治疗及预后分析[J].中国实验血液学杂志,2016,24(2):580-3.[Huang L,Yao HX.Clinical therapy and prognostic analysis of 61 patients with secondary hemophagocytic syndrome[J].Zhongguo Shi Yan Xue Ye Xue Za Zhi,2016,24(2):580-3.]
[21]Yi JH,Kim JH,Baek KK,et al.Elevated LDH and paranasal sinus involvement are risk factors for central nervous system involvement in patients with peripheral T-cell lymphoma[J].Ann Oncol,2011,22(7):1636-43.
[22]Chim CS,Sim J,Tam S,et al.LDH is an adverse prognostic factor independent of ISS in transplant-eligible myeloma patients receiving bortezomib-based induction regimens[J].Eur JHaematol,2015,94(4):330-5.
[23]Lust JA,Lacy MQ,Zeldenrust SR,et al.Reduction in C-reactive protein indicates successful targeting of the IL-1/IL-6 axis resulting in improved survival in early stage multiple myeloma[J].Am J Hematol,2016,91(6):571-4.
[24]Palumbo A,Anderson K.Multiple myeloma[J].N Engl J Med,2011,364(11):1046-60.
[25]Morgan GJ,Walker BA,Davies FE.The genetic architecture of multiple myeloma[J].Nat Rev Cancer,2012,12(5):335-48.
[26]Sonneveld P,Avet-Loiseau H,Lonial S,et al.Treatment of multiple myeloma with high-risk cytogenetics:a consensus of the International Myeloma Working Group[J].Blood,2016,127(24):2955-62.