【摘要】 目的 探究复发难治性多发性骨髓瘤（relapsed and refractory multiple myeloma, RRMM）患者的临床特征，明确影响其预后的关键因素，为临床制定个体化治疗方案提供参考。方法 患者均采用以达雷妥尤单抗为基础的治疗方案（达雷妥尤单抗联合硼替佐米、地塞米松）,8周为1个周期，共治疗2个周期。收集患者治疗前的临床资料（性别、年龄、国际分期系统分期、分型等）及实验室检查指标（血红蛋白、血肌酐、血清钙、骨髓浆细胞比率等）,依据欧洲血液骨髓移植组标准定义总生存期（OS）,采用IBM SPSS 22.0统计软件进行单因素及多因素分析。结果 单因素分析显示，骨病分级、血肌酐、血清钙、骨髓浆细胞比率、C-反应蛋白与RRMM患者预后相关（P<0.05）;logistic回归分析表明，骨病分级（OR=3.046,95%CI:1.218～7.622,P<0.05）、血肌酐（OR=5.489,95%CI:2.553～11.800,P<0.001）、血清钙（OR=1.121,95%CI:1.004～1.251,P<0.05）、骨髓浆细胞比率（OR=5.918,95%CI:2.687～13.036,P<0.001）是影响RRMM患者预后的独立危险因素。结论 RRMM患者临床特征具有异质性，骨病分级≥3级、血肌酐≥170μmol·L^-1、血清钙≥2.75 mmol·L^-1、骨髓浆细胞比率≥30%的患者预后较差，临床可针对上述危险因素实施针对性干预，以改善患者生存结局。更多还原

【Abstract】 Objective To investigate the clinical characteristics of patients with relapsed and refractory multiple myeloma（RRMM） and identify the key factors affecting their prognosis, so as to provide a reference for formulating individualized clinical treatment plans. Methods All patients were treated with a daratumumab-based regimen（daratumumab combined with bortezomib and dexamethasone）, with an 8-week cycle for a total of 2 cycles. Baseline clinical data（gender, age, International Staging System stage, subtype, etc.） and laboratory indicators（hemoglobin, serum creatinine, serum calcium, bone marrow plasma cell ratio, etc.） of the patients were collected. Overall survival（OS） was defined according to the criteria of the European Group for Blood and Marrow Transplantation. Univariate and multivariate analyses were performed using IBM SPSS 22.0 statistical software. Results Univariate analysis showed that bone disease grade, serum creatinine, serum calcium, bone marrow plasma cell ratio and C-reactive protein were correlated with the prognosis of RRMM patients（P<0.05）. logistic regression analysis indicated that bone disease grade（OR=3.046, 95% CI: 1.218-7.622, P<0.05）, serum creatinine（OR=5.489, 95% CI: 2.553-11.800, P<0.001）, serum calcium（OR=1.121, 95% CI: 1.004-1.251, P<0.05） and bone marrow plasma cell ratio（OR=5.918, 95% CI: 2.687-13.036, P<0.001） were independent risk factors for the prognosis of RRMM patients. Conclusion The clinical characteristics of RRMM patients are heterogeneous. Patients with bone disease grade≥3, serum creatinine ≥170 μmol·L^-1, serum calcium ≥2.75 mmol·L^-1, and bone marrow plasma cell ratio ≥30% have a poor prognosis. Clinical targeted interventions can be implemented for the above risk factors to improve the survival outcomes of patients.更多还原