Objective: To investigate the therapeutic effect and prognostic value of oligoclonal bands (OB) in multiple myeloma (MM) patients after autologous stem cell transplant (ASCT). Methods: The data of 156 patients with MM who underwent ASCT after inductive treatment in the Department of Hematology, Jiangsu Provincial People's Hospital from December 2013 to February 2022 were retrospectively analyzed, including 91 males and 65 females. The median age was 56 (26, 71) years. Patients were divided into two groups according to OB formation after ASCT treatment, including OB group (n=60) and non-OB group (n=96). The last follow-up date was August 31, 2023, and the follow-up period was 42 (18, 117) months. The clinical baseline characteristics and efficacy of the two groups were compared. Progression-free survival (PFS) and overall survival (OS) were compared between the two groups by Kaplan-Meier method. Cox risk regression modal was used to analyze the risk factors associated with prognosis. Results: There were no significant differences in age, type, stage, risk stratification, extramedullary disease (EMD), proportion of circulating plasma cells and induction therapy regimen between OB and non-OB groups (all P>0.05). The proportion of patients in OB group who achieved complete response (CR) or above after ASCT treatment was 93.3% (56/60), which was higher than that in non-OB group (80.2%, 77/96) (P=0.024). The negative rate of minimal residual disease (MRD) in OB group was 66.7% (40/60), which was higher than that in non-OB group (34.4%, 33/96) (P=0.001). The median PFS and OS in the OB group were not reached, and the median PFS and OS in the non-OB group were 28 (2, 80) months and 86 (2, 100) months, respectively. The PFS (P<0.001) and OS (P=0.017) of patients with OB were considerably longer. In the Cox multivariate analysis, OB was an independent prognostic factor for PFS in MM patients (HR=0.314, 95%CI: 0.153-0.644, P=0.002). Subgroup analysis showed that among high-risk patients with mSMART, the OS of patients in OB group was not reached, which was significantly better than that of non-OB group [71 (2, 90) months, P=0.046]. However, no significant difference was observed in the OS of patients with OB and those with non-OB in standard risk group (not reached vs not reached, P=0.103). In those with EMD at diagnosis, patients with OB had significantly better OS than those with non-OB [not reached vs 47 (6, 74) months, P=0.037]. However, no significant difference was observed in the OS of patients with OB and those with non-OB in those without EMD at diagnosis [not reached vs 86 (2, 100) months, P=0.130]. Conclusions: OB formation after ASCT treatment in MM patients is related to the efficacy and prognosis. OB formation can increase the negative MRD rate, prolong the OS and improve the prognosis, especially for newly diagnosed patients with extramedullary disease or patients with high-risk genetic characteristics.
目的： 探讨多发性骨髓瘤（MM）患者自体造血干细胞移植（ASCT）后出现寡克隆条带（OB）对患者疗效及预后的影响。 方法： 回顾性分析2013年12月到2022年2月江苏省人民医院血液科接受ASCT治疗的156例初诊MM患者，其中男91例，女65例，年龄［M（Q1，Q3）］为56（26，71）岁。根据ASCT治疗后OB形成情况将患者分为两组：OB组（n=60）与非OB组（n=96）。末次随访日期为2023年8月31日，随访时间为42（18，117）个月。比较两组患者临床基线特点及疗效。采用Kaplan-Meier法绘制生存曲线，比较两组患者无进展生存时间（PFS）及总生存时间（OS）的差异；采用Cox风险回归模型分析与预后相关的危险因素。 结果： OB组与非OB组患者在发病年龄、分型、分期、危险分层、是否合并髓外病变、初诊循环浆细胞比例、诱导治疗方案等方面差异均无统计学意义（均P>0.05）。OB组患者接受ASCT治疗后获得完全缓解（CR）及以上缓解程度比例为93.3%（56/60），高于非OB组患者的80.2%（77/96）（P=0.024）。OB组患者微小残留病（MRD）阴性率为66.7%（40/60），高于非OB组患者的34.4%（33/96）（P=0.001）。OB组PFS及OS均为未达到，非OB组PFS及OS时间分别为28（2，80）、86（2，100）个月，OB组较非OB组患者具有更长的PFS（P<0.001）和OS（P=0.017）。在Cox多因素分析中，OB形成是MM患者PFS的保护因素（HR=0.314，95%CI：0.153~0.644，P=0.002）。亚组分析发现，在Mayo骨髓瘤分层及风险调整治疗（mSMART）高危组患者中，OB组患者OS时间为未达到，优于非OB组患者的71（2，90）个月（P=0.046）；但在mSMART标危组患者中，OB组与非OB组OS均为未达到，差异无统计学意义（P=0.103）；在初诊合并髓外病变患者中，OB组OS为未达到，优于非OB组患者的47（6，74）个月（P=0.037）；但在初诊无髓外病变患者中，OB组OS为未达到，非OB组OS为86（2，100）个月，差异无统计学意义（P=0.130）。 结论： MM患者接受ASCT治疗后OB形成与疗效及预后相关，尤其对于初诊合并髓外病变或具有高危遗传学特征的患者，OB形成可提高患者MRD阴性率，延长患者OS时间，改善患者预后。.