| 刘林,谢志滨,谭远远,等.淋巴细胞与单核细胞比值和预后营养指数在达雷妥尤单抗治疗复发难治性多发性骨髓瘤中的预后评估作用[J].安徽医药,2026,30(7):1353-1358. |
| 淋巴细胞与单核细胞比值和预后营养指数在达雷妥尤单抗治疗复发难治性多发性骨髓瘤中的预后评估作用 |
| The prognostic role of LMR and PNI in daratumumab-treated relapsed/refractory multiple myeloma |
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| DOI：10.3969/j.issn.1009-6469.2026.07.016 |
| 中文关键词: 多发性骨髓瘤 达雷妥尤单抗 淋巴细胞与单核细胞比值 预后营养指数 预后 |
| 英文关键词: Multiple myeloma Daratumumab Lymphocyte to monocyte ratio Prognostic nutritional index Prognosis |
| 基金项目:安徽省教育厅科学研究重点项目( 2023AH052011)；蚌埠医学院自然科学重点项目( 2022byzd048) |
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| 中文摘要: |
| 目的探讨淋巴细胞与单核细胞比值( LMR)和预后营养指数(PNI)对达雷妥尤单抗(Dara)治疗背景下复发难治性多发性骨髓瘤( RRMM)病人预后的影响。方法回顾性选取 2022年 1月至 2024年 7月蚌埠医科大学第一附属医院应用 Dara治疗的 50例 RRMM病人作为研究对象。收集首次应用 Dara前 1周的各项临床指标，采用受试者操作特征曲线( ROC曲线)确定 LMR和 PNI的最佳临界值，并根据临界值分为高 LMR组( ≥3.42)和低 LMR组( <3.42)，高 PNI组( ≥41.97)和低 PNI组( <41.97)。比较不同分组的基线特征和疗效，联合 LMR和 PNI构建简易预后模型，根据危险因素的存在情况将病人分为高、中和低风险三组，采用 Kaplan-Meier法和 Cox比例风险模型进行生存和预后分析， ROC曲线分析上述指标在 Dara治疗 RRMM病人中的预后预测价值。结果与高 LMR组相比，低 LMR组具有更高的血肌酐水平［ 148.00(80.00，320.00)μmol/L比 76.00(55.00，95.00) μmol/L］(P=0.007)，PNI组内基线特征差异无统计学意义( P>0.05)。 Dara单周方案治疗结束后进行疗效评估显示，低 LMR和 PNI组的总有效率( ORR)均低于高 LMR和 PNI组( P<0.05)。中位随访时间为 11.4个月，生存分析显示低 LMR组的总生存期(OS)和无进展生存期( PFS)均短于高 LMR组( P<0.05)低 PNI组的 OS短于高 PNI组( P<0.05)。多因素 Cox回归分析显示 LMR和 PNI为影响 Dara治疗 RRMM病人 OS的独立危险因素(，P<0.05)LMR是影响 PFS的独立危险因素( P=0.007)。简易模型中，高风险组的 OS明显短于中低风险组( P<0.05)ROC曲线结果显示，L，MR、PNI和两者联合预测 Dara治疗 RRMM病人预后的曲线下面积( AUC)及其 95%CI分别为 0.80(0.67，0，.93)、 0.84(0.73，0.96)、 0.87(0.75，0.98)，两者联合( Z=6.16，P=0.006)优于 LMR和 PNI单一指标( Z=4.56、5.81，均 P<0.05)。结论 LMR和 PNI是 Dara治疗背景下 RRMM病人预后的独立危险因素，联合两者形成的简易预后模型具有较好的预后预测效能。 |
| 英文摘要: |
| Objective To investigate the impact of the lymphocyte-to-monocyte ratio (LMR) and the prognostic nutritional index(PNI) on the prognosis of patients with relapsed/refractory multiple myeloma (RRMM) treated with daratumumab (Dara).Methods A total of 50 RRMM patients treated with Dara at The First Affiliated Hospital of Bengbu Medical University, from January 2022 to July2024, were enrolled in this study. Clinical indicators were collected one week prior to the first administration of Dara. Receiver operat-ing characteristic curves (ROC curves) were used to determine the optimal cutoff values for LMR and PNI. Patients were divided intohigh LMR (≥ 3.42) and low LMR (< 3.42) groups, as well as high PNI (≥ 41.97) and low PNI (< 41.97) groups based on these cutoff val-ues. Baseline characteristics and treatment efficacy were compared across different subgroups. A simplified prognostic model was con-structed by combining LMR and PNI, categorizing patients into high-, median-, and low-risk groups based on the presence of risk fac-tors. Survival and prognostic analyses were performed using the Kaplan-Meier method and Cox proportional hazards model. Additional-ly, ROC curve analysis was employed to evaluate the predictive value of these indicators for prognosis in RRMM patients treated withDara.Results Compared to the high LMR group, the low LMR group had significantly higher serum creatinine levels [148.00 (80.00, 320.00) μmol/L vs. 76.00 (55.00, 95.00) μmol/L] (P = 0.007), while no significant differences in baseline characteristics were observed between the PNI groups (P > 0.05). Upon efficacy evaluation following completion of the Dara once-weekly regimen, both the low LMRand PNI groups demonstrated significantly lower overall response rates (ORR) compared to their high LMR and PNI counterparts (P < 0.05). With a median follow-up of 11.4 months, survival analysis revealed that the low LMR group had shorter overall survival (OS) and progression-free survival (PFS) than the high LMR group (P < 0.05), and the low PNI group had shorter OS than the high PNI group (P < 0.05). Multivariate Cox regression analysis identified LMR and PNI as independent risk factors for OS in Dara-treated RRMM pa-tients (P < 0.05), and LMR as an independent risk factor for PFS (P = 0.007). In the simplified prognostic model, the high-risk group ex-hibited significantly shorter OS compared to the median-and low-risk groups (P < 0.05). ROC analysis demonstrated that the areas un-der the curve (AUC) and 95% confidence interval (CI) for LMR, PNI, and their combination in predicting prognosis for RRMM patientstreated with Dara were 0.80 (0.67, 0.93), 0.84 (0.73, 0.96), and 0.87 (0.75, 0.98), respectively. The combined model (Z = 6.16, P = 0.006) outperformed either LMR (Z = 4.56, P < 0.05) or PNI (Z = 5.81, P < 0.05) alone.Conclusion LMR and PNI are independent prognostic factors in Dara-treated RRMM patients, and the simple prognostic model combining these two indicators demonstrates excel-lent predictive efficacy. |
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