多发性骨髓瘤伴髓外浸润25例临床分析

目的 研究多发性骨髓瘤(MM)伴髓外浸润患者的临床特点及治疗.方法 分析我科2006年7月至2008年7月收治的25例MM伴髓外浸润的患者,男:女为15:10,中位年龄55.2(30～65)岁.其中IgA 10例,IgG 9例,轻链λ5例,IgD 1例.髓外浸润最常见部位是肌肉和椎管.结果 在诊断时即有髓外浸润的患者,应用传统的化疗方案,如美法仑、泼尼松、沙立度胺或长春新碱、阿霉素、地塞米松,总有效率达到8/10例,随着髓内病变的好转髓外浸润也明显好转.而在后期出现的髓外浸润应用传统的化疗方案往往无效,我们选用含有硼替佐米的方案或顺铂、环磷酰胺、足叶乙甙、泼尼松(DECP),取得了较好的效果.接受DECP化疗的有效率为66.7%(10/15),接受硼替佐米的有效率为4/8例.结论 MM疾病进展后伴髓外浸润患者治疗效果差,进展迅速,常规化疗方案治疗效果较差,应尽早应用新药以及一些二线化疗方案.

A clinical analysis of 25 cases of multiple myeloma compficated by extramedullary plasmacytomas

Objective To investigate the clinical features of multiple myeloma (MM) complicated by extramedullary plasmacytomas(EM). Methods Twenty five patients were enrolled into the study. The proportion male to famale was 15:10 and the median age 55. 2 years. The distribution of different isotypes was IgA ten, IgG nine and light chain λ five. The sites of complicating plasmacytoma included muscle, bone, skin, rectum, and testicles. The most common site was muscle. Results Patients with complicated extramedullary plasmacytomas at the time of diagnosis received traditional treatment, including vincristiuum, adriamycin, dexamethasonum, mephalan, presnisone, thalidomide and bortezomib. Rates of overall response (ORR) were 80%. Plasmacytomas occurring after the diagnosis of MM received cisplatin, etoposide, cyclophosphamide, presnisone, or bortezomib ORR were 66. 7% ,50. 0%. Conclusion These results lend support to the efficacy of bortezomib in the treatment of plasmacytoma. MM cases with unconventional disease recurrence are likely to be seen due to sub-clinical seeding of turnout cells suggestive of the presence of an EM clone of plasma cells with a high degree of chemoresistance. Available data in the literature concerning the optimal therapy for patients with EM relapse were reviewed.