多发性骨髓瘤继发急性淋巴细胞白血病2例并文献复习

目的探讨多发性骨髓瘤继发急性淋巴细胞白血病患者的临床表现及治疗。方法对2017年7月及2021年6月首都医科大学附属北京朝阳医院收治的2例多发性骨髓瘤继发急性淋巴细胞白血病患者的临床表现及治疗经过进行回顾性分析, 并复习相关文献。结果 2例患者多发性骨髓瘤治疗达完全缓解, 7～8年后诊断急性淋巴细胞白血病, 给予VDCP方案治疗后达完全缓解, 总生存时间长于1年。结论多发性骨髓瘤患者随着生存期延长, 第二肿瘤的发生逐渐增多, 需定期随访, 争取早发现、早治疗。     

多发性骨髓瘤继发急性髓系白血病自发缓解一例并文献复习

目的观察多发性骨髓瘤继发急性髓系白血病出现自发缓解的影响因素、病理变化、自然病程,以探究多发性骨髓瘤病情变化过程中的诊查治疗思路。方法回顾性分析上海中医药大学附属龙华医院收治的1例多发性骨髓瘤继发急性髓系白血病患者的临床资料,并复习相关文献。结果该例患者确诊多发性骨髓瘤后行BCD方案诱导化疗,病程中出现继发急性髓系白血病,暂缓治疗1个月后,复查血象、骨髓象提示急性髓系白血病自发缓解,约4个月后患者急性白血病复发,最终死亡。结论多发性骨髓瘤治疗过程中出现继发急性髓系白血病的案例并不少见,且多提示病情变化,预后不良。本例患者虽罕见地出现了继发白血病的自发缓解,但无进展生存时间短,相关个体化诊治方案需进一步探索。     

VAD与VTD方案治疗初治多发性骨髓瘤的疗效分析

目的探讨VAD方案和VTD方案治疗初治多发性骨髓瘤的疗效。方法回顾性分析43例初治多发性骨髓瘤患者的治疗情况,其中VAD治疗组24例,VTD治疗组19例。结果 VAD治疗组有效率62.5%（15/24）,VTD治疗组有效率68.4%（13/19）,两治疗组疗效差异无统计学意义（P〉0.05）。不良反应中,心脏毒性发生率VAD治疗组高于VTD治疗组,差异有统计学意义（P〈0.05）。结论对于伴有心脏功能异常的初治多发性骨髓瘤患者应首选VTD方案治疗。     

长春瑞滨联合吡柔比星治疗多发性骨髓瘤临床观察

目的观察长春瑞滨治疗多发性骨髓瘤的临床疗效和毒副作用.方法治疗组在VAD方案中,用长春瑞滨(NVB)代替长春新碱(VCR)与吡喃阿霉素、地塞米松组成NTD方案治疗多发性骨髓瘤10例;对照组以长春地辛(VDS)代替长春新碱与吡喃阿霉素、地塞米松组成VTD方案治疗多发性骨髓瘤10例,比较两组的疗效和毒副作用.结果两组总有效率均为70.0%;VTD组周围神经毒性发生率为40.0%,NTD组为10.0%.结论 NTD方案对多发性骨髓瘤有较好的治疗效果,周围神经毒性有明显降低的趋势.     

多发性骨髓瘤化疗后发生急性髓系白血病一例并文献复习

多发性骨髓瘤(MM)患者比普通人有更大的几率发生第二肿瘤,且大部分为AML/MDS。男性及诊断多发性骨髓瘤年龄小于60岁的年轻患者比女性及诊断多发性骨髓瘤年龄大于60的患者发生血液学恶性肿瘤的可能性大。MM治疗后继发急性白血病的报道越来越多,但MM患者继发白血病以及其他第二肿瘤的机制及治疗目前尚不清楚。MM患者继发白血病后病情进展迅速,死亡率高,化疗后达完全缓解率低。     

血液系统双原发恶性肿瘤三例并文献复习

目的提高临床医师对血液系统双原发恶性肿瘤（DPMN）的认识。方法对北京中医药大学东直门医院收治的3例血液系统DPMN的临床资料进行综合分析,结合文献讨论。结果2例为血液系统异时性双原发恶性肿瘤（MDPMN）,分别为多发性骨髓瘤继发急性粒单核细胞白血病和弥漫大B细胞淋巴瘤继发急性单核细胞白血病,在第二恶性肿瘤明确诊断后,经标准方案化疗后均未缓解后死亡,生存时间分别为3、4个月。另1例为血液系统同时性双原发恶性肿瘤（SDPMN）,弥漫大B细胞淋巴瘤合并骨髓增殖性肿瘤,经6个周期化疗后至今完全缓解。结论对血液系统DPMN患者进行长期、规律的随访,早期诊断及治疗是改善预后的关键。     

淋巴结阴性结肠癌伴同时性肝转移患者的临床病理因素分析*

目的:分析淋巴结阴性结肠癌患者发生同时性肝转移的危险因素,提高高危患者随访的效率和早诊率。方法:回顾性分析2008年1 月至2012年12月就诊北京肿瘤医院胃肠肿瘤中心并且行手术治疗的140 例淋巴结阴性结肠癌患者临床病理资料,通过单因素和多因素分析,研究淋巴结阴性结肠癌同期肝转移的高危因素。结果:140 例淋巴结阴性结肠癌患者同期肝转移13例（9.2%）,61.5%（8/ 13例）的患者伴有不全性结肠梗阻,6 例患者接受原发灶和肝转移灶同期手术治疗。单因素分析和多因素分析均提示脉管浸润（P = 0.010）和术前CEA 水平异常（P = 0.004）是淋巴结阴性结肠癌患者发生同时性肝转移的独立危险因素。结论:淋巴结阴性结肠癌存在较高的同时性肝转移风险,脉管浸润和术前CEA 水平异常是这类患者发生同期肝脏转移的高危因素,对具有该特征的患者在就诊时或根治术后应该针对性地检查肝脏情况,避免漏诊。      

多发性骨髓瘤治疗缓解后继发急性髓系白血病一例并文献复习

目的:探讨多发性骨髓瘤治疗缓解后继发急性髓系白血病的治疗。方法:回顾性分析华中科技大学协和深圳医院收治的1例多发性骨髓瘤缓解后继发急性髓系白血病患者的诊疗过程，并复习相关文献。结果:患者经过常规化疗后效果良好，且多发性骨髓瘤也处于持续缓解状态。结论:对于多发性骨髓瘤治疗缓解后继发急性髓系白血病患者，接受标准化疗及大剂量阿糖胞苷交替化疗能获得持续缓解，且耐受性好。     

硼替佐米联合自体造血干细胞移植治疗多发性骨髓瘤的临床分析

目的探讨硼替佐米联合自体造血干细胞移植治疗多发性骨髓瘤的疗效和安全性。方法对1例轻链型多发性骨髓瘤患者,采用VTD方案（硼替佐米1.3 mg/m2,d 1、4、8、11;沙利度胺200 mg,d 1～14;地塞米松10 mg,d 1～4、d 9～12）化疗3个周期获得完全缓解后再行自体造血干细胞移植,监测M蛋白、肝肾功能、骨髓像、血象等指标,移植后再行白介素-2的免疫治疗。结果自体造血干细胞移植后患者造血重建顺利,相关并发症控制较好,随访至今一直无病生存。结论硼替佐米联合自体造血干细胞移植治疗多发性骨髓瘤是安全有效的。     

吡柔比星和地塞米松联合硼替佐米方案与联合长春新碱方案治疗多发性骨髓瘤的疗效比较

目的:比较BTD化疗方案（吡柔比星+地塞米松+硼替佐米）和传统VTD化疗方案（吡柔比星+地塞米松+长春新碱）治疗多发性骨髓瘤的近期疗效、临床受益反应以及不良反应。 方法:回顾性收集2011年6月至2017年12月,在我院住院治疗的183例多发性骨髓瘤患者。VTD组106例:长春新碱0.4 mg/d,d1~4+盐酸吡柔比星10 mg/d,d1~4+ 地塞米松40 mg/d,d1~4。BTD组77例:硼替佐米1.3 mg/(m2?d),d1,4,8,11+盐酸吡柔比星10 mg/d,d1~3+ 地塞米松40 mg/d,d1~4,8~11。两组均21天为一个疗程,连续使用4~6个疗程后评估。 结果:BTD组总有效率为58.44%,VTD组为33.96%,两组比较差异有统计学意义（P<0.05）。BTD组有84.42%患者能从临床治疗中获益,VTD化疗组有69.81%患者从治疗中获益,BTD化疗组患者获益明显优于VTD化疗组,差异具有统计学意义（P<0.05）。两组的主要不良反应均为周围神经病变和白细胞下降,两组比较无统计学差异（P>0.05）。在腹泻和乏力方面BTD组患者发生的几率明显高于VTD组患者,而在脱发方面BTD组发生率明显低于VTD组,两组比较差异有统计学意义(P<0.05)。 结论:与传统的VTD化疗方案相比,BTD化疗方案治疗多发性骨髓瘤,具有更好的总有效率和更优的临床受益反应,而不良反应两组接近,值得临床推广应用。     

Breast cancer and synchronous multiple myeloma as a diagnostic challenge: Case report and review of literature

Multiple myeloma is a hematological malignancy, which sometimes creates difficulties in diagnosis, based on the presence of monoclonal protein in serum/urine and plasmocyte infiltration in the bone marrow, and on the other hand, synchronous cancers are also a diagnostic challenge. We present a case report of a patient with concurrent breast cancer and multiple myeloma.A 68-year-old woman was admitted to the hospital with diagnosis of left breast cancer in first stage of the disease. In the past, she had had several episodes of thrombocytopenia, leucocytosis, and mild anaemia, which were followed by hematologist in outpatient setting. She was operated and started adjuvant chemotherapy. During treatment, episodes of hematological abnormalities were observed. After completion of the chemotherapy for breast cancer, the patient was observed and short time after that multiple myeloma was diagnosed as a synchronous cancer. Patient was first treated for breast cancer, then subsequently for multiple myeloma (2 lines therapy: CTD and VMP). We describe diagnostic problems with multiple myeloma; however, they could be caused by curation of breast cancer, which might have supressed the proliferation of plasmocytes and could delay the diagnosis. All symptoms of multiple myeloma were interpreted as a secondary effect of chemotherapy. Review of the literature shows the clinical approaches in such situations.     

A Report of Disseminated Carcinomatosis of the Bone Marrow Originating from Transverse Colon Cancer Successfully Treated with Chemotherapy Using XELOX plus Bevacizumab

A 61-year-old male, who had been admitted to another hospital due to disseminated intravascular coagulation (DIC), was referred to our hospital. Total colonoscopy, abdominal dynamic CT and positron-emission tomography revealed bone metastasis and multiple lymphocytic metastases from transverse colon cancer in addition to disseminated carcinomatosis of the bone marrow (DCBM). We immediately performed chemotherapy with XELOX + bevacizumab and denosumab against DCBM from transverse colon cancer in order to avoid radical surgery. In addition, we initiated the administration of recombinant human soluble thrombomodulin for 1 week to treat DIC. The patient was able to tolerate and receive 4 cycles of chemotherapy without any severe side effects. After receiving the 4 cycles of treatment, he recovered from DIC, and the bone and multiple lymphocytic metastases disappeared.Key words: Disseminated carcinomatosis of bone marrow, Chemotherapy, Transverse colon cancer, Disseminated intravascular coagulation     

Analyses of the clinical characteristics of 49 cases of malignancy with multiple bone lesions as the first manifestation

Objective To investigate the clinical features of several cases of malignancy with multiple bone lesions as the first manifestation. Methods Forty-nine cases of malignancy with multiple bone lesions as the first manifestation were retrospectively analyzed from May 2018 to July 2019. All patients complained of "pain at the site of bone lesion" upon admission. Baseline patient information, such as age, gender, location of bone lesions, etiology, diagnosis method, time of onset was collected. Results The median age of the patients was 56 years old, of which 83.7％ (41/49) were aged ≥50 years. The median time of onset was 2 months. Among the cases, 40 were confirmed as solid tumor bone metastasis, whereas the remaining 9 cases as hematological system tumor. Lung cancer and multiple myeloma were the main tumor types, accounting for 40.8％ (20/49) and 16.3％ (8/49), respectively. Other common causes were seven cases of cancer affecting the digestive system (three cases of liver cancer, three cases of gastric cancer, and one case of esophageal cancer), as well as seven cases of unknown primary cancer. Half of the solid tumors had only multiple bone metastases but no other distant metastasis. Conclusion Multiple bone lesions accompanied by pain may be the first clinical manifestation in various malignant tumors. The common tumor types were lung cancer, multiple myeloma, and digestive system tumor. It is more common in people aged 50 years and older. Multiple bone lesions might be the only metastasis site of some solid tumors, and its mechanism needs further investigation.     

Relapse of Aggressive Myeloma after Complete Remission in Secondary Acute Leukemia: Coincidence or Consequence?

We describe a patient with multiple myeloma who developed secondary acute myelomonocytic leukemia after long-term melphalan treatment. Following two courses of low-dose cytarabine, complete remission of the A.M.L. was achieved. Shortly thereafter an aggressive relapse of the quiescent myeloma occurred with acute renal failure and massive infiltration of bone marrow with multinucleated giant plasma cells. Although it is well known that administration of melphalan to patients with multiple myeloma increases the likelihood of A.M.L., this case demonstrates that treatment of A.M.L. in a patient with multiple myeloma may perhaps influence the course of multiple myeloma.     

结直肠癌骨转移的临床特点及治疗(附104例)

目的:探讨结直肠癌骨转移的临床特点,提高结直肠癌骨转移诊疗水平.方法:通过对中国医科大学附属盛京医院2012年1月1日至2015年1月1日收治的104例结直肠癌骨转移患者资料进行回顾性分析,分析其临床特征,绘制生存曲线,总结诊疗规律.结果:2012年1月1日至2015年1月1日期间我院共收治结直肠癌骨转移患者104例,占同期结直肠癌患者的10.0%(104/1 038),其中结肠癌骨转移38例,直肠癌骨转移66例.多发骨转移60例(57.7%),单发骨转移44例(42.3%),常见转移部位依次为腰椎(38.5%)、骶骨(32.7%)、胸椎(30.8%)、肋骨(26.9%)、四肢骨(19.2%)、肩胛骨(3.8%)、颌面骨(1.9%).共有74例患者合并有远处脏器转移(71.2%),≥2处者46例,肺脏42例,肝脏40例,腹膜后淋巴结14例,腹股沟淋巴结6例,肾上腺4例,脑2例.确诊骨转移的中位时间为(26.1±3.3)个月.从确诊骨转移之日算起,中位生存期为(22.5±4.0)个月.结论:结直肠癌骨转移患者多合并远处脏器转移;直肠癌比结肠癌更易发生骨转移.     

左、右半结肠癌骨转移临床特征及生存分析

目的:探讨左半结肠癌（left sided colon cancer,LSCC）和右半结肠癌（right sided colon cancer,RSCC）骨转移病人的临床特征,筛选3年生存影响因子,为结肠癌骨转移临床诊治及预后提供参考依据。方法:对漯河市中心医院2007年1月至2015年12月收治的103例结肠癌骨转移病例资料进行回顾性分析,据解剖位置将64例纳入LSCC组,39例纳入RSCC组,对比分析其两组病人的临床特征,筛选3年生存影响因子。结果:卡方检验单因素分析示肿瘤位置、TNM分期、伴肺转移、骨转移后治疗及双磷酸盐治疗与结肠癌骨转移3年生存率相关(P<0.05),具有统计学意义。Logistis回归多因素统计分析示:肿瘤位置、TNM分期影响结肠癌骨转移患者的预后。结论:结肠癌骨转移预后可能与肿块位置、TNM分期、伴肺转移、骨转移后治疗、双磷酸盐治疗等多种临床因素相关。其中肿瘤位置、TNM分期是结肠癌骨转移3年生存的独立预后危险因素。本文为区分左右半结肠癌骨转移不同的临床特征及预后评价提供了依据。     

Plasma cell myeloma of the skull base: Report of two cases

Plasma cell myeloma (PCM) of the skull base is rarely encountered in neurosurgical practice. PCM has a wide spectrum of pathology, including a quite benign, solitary plasmacytoma (SPC), and an extremely malignant, multiple myeloma (MM) at the two ends of the spectrum. We have described two patients with PCM of the skull base, of which one harbored SPC, and the other progressed to MM. In case 1, a 46-year-old man presented with left multiple cranial nerve impairments and had a large skull base tumor. Subtotal removal was performed. The specimen and general examination, including bone marrow aspiration, revealed SPC. Postoperatively 50 Gy of external radiotherapy was administered. The patient has no manifestation of MM 24 months after the initial presentation. In case 2, a 53-year-old woman presented with left abducens palsy and had a left petroclival osteolytic mass. Gross total resection was performed. The specimen revealed a plasmablastic tumor, i.e., myeloma. General examination established the diagnosis of MM. She was administrated adjuvant chemotherapy and autologous bone marrow transplantation. She is alive without local recurrence 30 months after the initial presentation.     

Myeloma appearance after local external beam radiotherapy jet: Is it a new entity?

Multiple myeloma, also known as Kahler's disease, is a cancer of plasma cells that abnormally accumulate in bone marrow. Radiation therapy may be indicated in multiple myeloma to relieve pain, alleviate spinal cord compression or reduce tumor mass. We report the case of a patient presenting a multiple myeloma, treated with radiation therapy for a spinal cord compression, who developed, eleven months later, an in-field subcutaneous relapse. We called this phenomenon myeloma appearance after local external beam radiotherapy jet (MAALEJ). A review of literature was performed trying to explain this uncommon relapse feature.