背景:为了提高多发性骨髓瘤(MM)的早期检出率,自2014年起,复旦大学附属中山医院在医院人群中开展了M蛋白筛查系统,并将基于电泳的单克隆免疫球蛋白(M蛋白)筛查纳入血液生化面板.这项研究更新了通过筛查驱动和症状驱动方法诊断的MM患者的7年随访结果。
方法:回顾性研究通过回顾2014年1月至2021年10月的浆细胞疾病数据库,比较了通过两种模式诊断的患者的特征和结局。筛查驱动组包括在无关的医疗状况检查或常规检查期间通过筛查系统诊断的患者。相比之下,因骨髓瘤相关的终末器官损害就诊或转诊至血液科的患者被归类为症状驱动组.
结果:在7年中进行了3,110,218次血清蛋白电泳(SPEP)测试,1.95%(60,609例)的患者SPEP结果为阳性。在911例确诊的MM病例中(不包括并发淀粉样变性),366人被分配到筛查驱动组,症状驱动组545人。与症状驱动组相比,筛查组有更多的IgG亚型,早期的国际舞台系统阶段,减少疾病相关症状,较低的ECOG分数,少髓外疾病,骨髓浆细胞的比例较低,和较低水平的乳酸脱氢酶。两组的前线反应结果相似。与症状驱动组相比,通过筛查检测到的患者中位无进展生存期(PFS)显着提高(62.2vs.24.9个月,p<0.001,HR:2.12,95%CIs:1.69-2.65),中位随访时间为32.6个月和27.4个月。此外,筛查组患者的中位总生存期(OS)明显更长(未达到vs.62.3个月,p<0.001,HR:2.49,95%CIs:1.81-3.41)。在对公认的骨髓瘤预后因素进行调整后,筛查驱动的诊断模式仍然是MM患者PFS和OS改善的独立预后因素.
结论:在医院人群中对MM进行常规M-蛋白筛查可导致更早的诊断和更好的患者预后。
BACKGROUND: To improve the early detection rate of multiple myeloma (MM), the M-protein screening system has been performed in the hospital population at Zhongshan Hospital Fudan University since 2014, with electrophoretic-based monoclonal immunoglobulin (M-protein) screening integrated into the blood biochemistry panel. This study updated 7-year follow-up findings of MM patients diagnosed by screening-driven and symptom-driven approaches.
METHODS: The retrospective study compared the characteristics and outcomes of patients diagnosed through two patterns by reviewing the plasma cell disease database from January 2014 to October 2021. The screening-driven group included patients diagnosed through the screening system during workups of unrelated medical conditions or routine checkups. In contrast, patients who visited or were referred to the hematological department due to myeloma-related end-organ damage were categorized into the symptom-driven group.
RESULTS: There were 3,110,218 serum protein electrophoresis (SPEP) tests performed during 7 years, with 1.95% (60,609) patients yielding positive SPEP results. Of 911 confirmed MM cases (excluding concurrent amyloidosis), 366 were assigned to the screening-driven group, while 545 were to the symptom-driven group. Compared to the symptom-driven group, the screening group had more IgG subtypes, earlier International Stage System stages, fewer disease-related symptoms, lower ECOG scores, less extramedullary disease, a lower percentage of bone marrow plasma cells, and a lower level of lactate dehydrogenase. Frontline response results of two groups were similar. Patients detected through screening had a significantly improved median progression-free survival (PFS) than the symptom-driven group (62.2 vs. 24.9 months, p < 0.001, HR: 2.12, 95% CIs: 1.69-2.65), with median follow-ups of 32.6 and 27.4 months. Furthermore, the median overall survival (OS) was significantly longer in patients of the screening group (not reached vs. 62.3 months, p < 0.001, HR: 2.49, 95% CIs: 1.81-3.41). After being adjusted for well-acknowledged myeloma prognostic factors, the screening-driven diagnostic pattern remained an independent prognostic factor indicating improved PFS and OS in MM patients.
CONCLUSIONS: Routine M-protein screening for MM in the hospital population results in an earlier diagnosis and better patient outcomes.