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目的:观察疗效评估为非常好的部分缓解(VGPR)及以上的IgA型多发性骨髓瘤(MM)患者中血清免疫球蛋白重/轻链(HLC)和游离轻链(FLC)及免疫固定电泳(IFE)的结果,探讨HLC在IgA型MM患者疗效和预后评估中的作用。方法:收集54例治疗后疗效评估为VGPR及以上IgA型MM患者血清样本,采用散射免疫比浊法在全自动SPA plus特定蛋白分析仪上进行HLC及FLC检测。结合同期IFE检测结果,评价HLC在IgA型MM疗效及预后判断中的价值。结果:(1)54例IgA型MM患者中,22例rHLC(HLC IgA-κ/IgA-λ比值)异常,其中IgA-κ型13例,IgA-λ型9例,rHLC检测结果的中位数分别为4.30、0.29;rHLC异常组与rHLC正常组中位无进展生存期(PFS)分别为7.8个月与13.0个月(P=0.018);中位总生存期(OS)分别为11.2个月和13.2个月(P=0.048)。(2)54例患者中,15例IFE、rHLC、rFLC 3项指标均正常为A组;12例有1项指标异常为B组;18例有2项指标异常为C组;9例3项指标均异常为D组;A、B、C、D组中位PFS分别为16.6个月、14.2个月、7.8个月、7.0个月(P=0.019);中位OS分别为18.7个月、16.5个月、9.4个月、9.3个月(P=0.016)。结论:达到VGPR及以上疗效的MM患者仍能检出rHLC的异常,rHLC异常提示患者预后不良;HLC与FLC及IFE检测的联合应用可以更好地对IgA型MM患者进行预后监测。
OBJECTIVE: To observe the effect of serum immunoglobulin heavy / light chain (HLC) and free light chain (FLC) and immunofixation electrophoresis in patients with IgA multiple myeloma (MM) with very good partial response (VGPR) (IFE), to investigate the role of HLC in assessing the efficacy and prognosis of IgA-type MM patients. Methods: Serum samples from 54 MM patients with VGPR and above were collected after 54 treatments. HLC and FLC were performed on a fully automatic SPA plus specific protein analyzer using a scattering immunoassay. Combined with the same period of IFE test results, evaluation of HLC IgA type MM efficacy and prognostic value. Results: (1) Among the 54 patients with IgA type MM, 22 cases had abnormality of HLC IgA-κ / IgA-λ ratio, including 13 cases of IgA-κ and 9 cases of IgA- The median progression-free survival (PFS) were 7.8 months and 13.0 months respectively (P = 0.018); the median overall survival (OS) was 11.2 Month and 13.2 months (P = 0.048). (2) Of 54 patients, 15 of IFE, rHLC and rFLC were normal in group A, 12 in group B, 1 in group B was abnormal, 12 in group C were abnormal in 2 and 9 in group 3 The median PFS of group A, B, C and D were 16.6 months, 14.2 months, 7.8 months and 7.0 months respectively (P = 0.019). The median OS was 18.7 months, 16.5 months, 9.4 months, 9.3 months (P = 0.016). Conclusion: The abnormality of rHLC can still be detected in patients with MM with VGPR and above efficacy. The abnormality of rHLC indicates the poor prognosis of patients with MM. The combination of HLC with FLC and IFE can better monitor the prognosis of MM with IgA.