Therapeutic effect and prognostic influencing factors of IgD multiple myeloma in the new immunotherapy era
10.3760/cma.j.cn115356-20220126-00025
- VernacularTitle:新型免疫治疗时代IgD型多发性骨髓瘤疗效及预后影响因素分析
- Author:
Qiong LIU
1
;
Ying WANG
;
Feng ZHU
;
Hai CHENG
;
Zhiling YAN
;
Kunming QI
;
Wei SANG
;
Depeng LI
;
Zhenyu LI
;
Kailin XU
;
Haiying SUN
Author Information
1. 徐州医科大学附属医院血液内科，徐州 221002
- Keywords:
Multiple myeloma;
Immunoglobulin D;
Immunotherapy;
Chimeric antigen receptor T-cell;
Prognosis
- From:
Journal of Leukemia & Lymphoma
2022;31(7):407-411
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical characteristics, efficacy and prognostic influencing factors of IgD multiple myeloma (MM) in the new immunotherapy era.Methods:The clinical data of 29 patients diagnosed with IgD MM in the Affiliated Hospital of Xuzhou Medical University from March 2014 to February 2021 were retrospectively collected. The clinical characteristics, treatment regimens and efficacy, especially the efficacy of new drugs and immunotherapy for the disease were analyzed. Kaplan-Meier method was used to analyze the overall survival (OS) and progression-free survival (PFS). Multivariate Cox proportional risk model was used for analysis of prognostic influencing factors.Results:The median age of patients was 58 years. There were 20 cases (69.0%) below 65 years, 12 cases (41.4%) of complicated with stomach function damage, 6 cases (20.7%) of extramedullary invasion. All patients were treated with combined therapy containing proteasome inhibitor bortezomib in the first-line therapy, and the overall response rate was 82.8% (24/29). Among 21 relapsed/refractory patients, 12 patients were treated with the second-line or above treatment regimen chimeric antigen receptor T cell (CAR-T) immunotherapy, including 9 cases achieving very good partial remission (VGPR) or above; 5 patients were treated with the new drug daratozumab, including 1 case achieving complete remission (CR). The median OS time of 29 patients was 48 months (95% CI 17-79 months), the median PFS time after the first-line treatment was 9 months (95% CI 3-15 months), and the median PFS time after the second-line treatment was 11 months (95% CI 1-21 months). Multivariate Cox regression results showed that CAR-T therapy is an independent influencing factor of the prognosis of relapsed/ refractory IgD MM patients ( HR = 0.094, 95% CI 0.019-0.473, P = 0.004). Conclusions:IgD MM patients are characterized with lower onset age, more renal function damage and a high incidence of extramedullary invasion. The first-line therapy containing proteasome inhibitor has a better short-term efficacy, and CAR-T therapy can improve the remission rate and survival rate of relapsed/refractory IgD MM to a certain extent.
