Meningeal involvement in multiple myeloma

A patient with multiple myeloma with a mass in the nasopharyngeal was diagnosed. He received melphalan autograft and radiotherapy, and obtained complete remission. He relapsed 3 months later, with meningeal involvement and without systemic relapse. He received intrathecal and systemic chemotherapy, without neurological improvement and died 4 weeks after relapse.     

Long‐term survival in multiple myeloma

The survival of multiple myeloma patients has improved very significantly over the last decade. Still median overall survival is inferior to 5 years. A small proportion of patients survive longer than 10 years. In this paper we discuss four cases illustrating the nonhomogeneous clinical presentation and evolution of this subset of patients. Surprisingly, these long survivors do not always have deep responses and some require frequent treatments, which include autologous stem cell transplantation and novel drugs. The authors discuss several aspects of these clinical histories, including treatment options, raising hypothesis on their relation with long survivorship which may be important to have in consideration when studying this subject.     

Carfilzomib in multiple myeloma

Introduction: Advances in drug therapy for multiple myeloma (MM) during the previous decade have improved survival outcomes; however, the disease remains incurable as patients eventually relapse or become refractory to all available therapies. Therefore, there is a clear need for more effective and well-tolerated treatments.

Areas covered: We review preclinical and clinical data regarding the use of carfilzomib, a proteasome inhibitor that is structurally and mechanistically distinct from bortezomib, for the treatment of MM patients. Carfilzomib pharmacokinetics, pharmacodynamics, efficacy, safety and tolerability are summarized, based on Phase I/II trial data.

Expert opinion: Carfilzomib represents a significant advance in the management of relapsed and/or refractory MM patients, including those intolerant or resistant to bortezomib. High response rates have been demonstrated with carfilzomib as a single agent or in combination with alkylating agents, immunomodulators and corticosteroids, even among patients who have failed multiple prior therapies. Carfilzomib also has significant potential in the frontline setting, with encouraging response and survival rates observed for combination regimens. Further evaluation of carfilzomib-containing regimens is ongoing in Phase III trials and investigator-sponsored studies, which include combinations with novel investigational agents. These findings will shape the future role of carfilzomib for MM patients across multiple settings.     

多发性骨髓瘤免疫表型研究进展

多发性骨髓瘤(MM)是一种克隆性的B细胞疾病,以恶性浆细胞(PC)在骨髓中大量增殖,产生溶骨性破坏及过量单克隆免疫球蛋白为主要表现。MM的诊断主要依靠骨髓中存在浆细胞浸润,血、尿中存在一定量的单克隆蛋白以及瘤细胞浸润或单克隆蛋白引起的器官损害(高钙血症、肾功能不全、贫血、骨质破坏等)。本文就流式细胞术免疫表型检测对MM诊断和预后意义的研究进展做一综述。     

Heat insoluble cryoglobulin associated with gangrene in multiple myeloma

Cryoglobulins are immunoglobulins that have tendency to precipitate in temperatures below 37 degrees C and dissolve with rewarming. Monoclonal cryoglobulins are usually associated with a distinct hematological disorder and often are asymptomatic. Heat insoluble cryoglobulin has been described with Sjogren's syndrome and glomerulonephritis but, not with multiple myeloma. Severe sensitivity to cold occurs with high thermal insolubility of the cryoprotein, with dramatic symptoms when exposed to minimal lowering of the temperature. We report a case of a 49 year old man with multiple myeloma and an unusual type I cryoglobulin that caused occlusive gangrene. The cryoglobulin appeared as a milky white precipitate that was resistant to re-suspension and did not dissolve at 37 degrees C. Immunoelectrophoresis of the cryoglobulin, which dissolved at 56 degrees C, showed it to be composed of a monoclonal IgG kappa protein (3.5 g/dl). Unlike most high thermal insoluble cryoglobulin, cold associated symptoms were not seen. In addition to steroids, plasmapheresis was initiated thrice a week with albumin fluid replacement. Plasmapheresis caused a marked decline in cryocrit levels from 21% to less than 0.5% in 9 days after 4 procedures with resolution of the gangrene of the feet and after 6 treatments, vasculitic symptoms improved dramatically. The cryoglobulin test was negative 2 weeks after initiation of treatment. The patient was treated for the myeloma and there was no recurrence of occlusive symptoms. Proper laboratory procedure and careful examination and handling of cryoglobulinemic samples facilitate detection of unusual cryoglobulins. This is a unique report of multiple myeloma with gangrene of lower extremities that has a heat insoluble cryoglobulin.     

NT-proBNP在多发性骨髓瘤诊断中的应用研究

目的研究血清N端前脑钠肽(NT-proBNP)水平在多发性骨髓瘤中的诊断价值。方法收集整理徐州医科大学附属医院2017年12月至2018年12月门诊及住院明确诊断为多发性骨髓瘤并同时检测了M蛋白和血清NT-proBNP的患者共132例,并将收集的132例按NT-proBNP值分低值、中值、高值3个小组,另外收集同时检测了M蛋白和血清NT-proBNP的健康体检者132例作为健康对照组。用SPSS18.0软件通过箱体图、秩和检验和ROC曲线对相应数据进行分析统计。结果多发性骨髓瘤患者低值、中值、高值3组NTproBNP水平都高于健康对照组,组间差异均有统计学意义(P<0.01)。以M蛋白电泳为金标准,分析NTproBNP对多发性骨髓瘤的诊断价值,做ROC曲线,其ROC曲线下面积为0.899,NT-proBNP最佳诊断临界值为1 381.0pg/mL,用该值诊断多发性骨髓瘤的灵敏度为76.9%,特异度为84.6%。结论 NT-proBNP在多发性骨髓瘤辅助诊断中具有重要的临床意义,且通过ROC曲线分析,可以发现其诊断多发性骨髓瘤的灵敏度、特异度较高,为多发性骨髓瘤的诊断提供另一种简单的有效途径。     

多发性骨髓瘤的治疗现状和规范

多发性骨髓瘤(MM)是一种异常浆细胞过度增殖的恶性肿瘤,传统化疗效果不佳,完全缓解率(CR)＜10％,中位生存期仍然只有33个月左右.自体造血干细胞移植(ASCT)的应用改善了MM的疗效,含新药的诱导化疗能达到与移植相似的疗效.目前认为,含新药的诱导治疗序贯ASCT是≤65岁适合移植的初治MM患者的治疗策略,单次移植后疗效≥非常好的部分缓解的患者不需要二次移植.移植后的巩固和维持治疗是有益的.对于＞65岁及不适合移植的初治MM患者,含新药的诱导治疗和维持治疗同样是合适的.     

116例多发性骨髓瘤免疫特征表型分析

目的了解多发性骨髓瘤(MM)的免疫表型特征,以及CD45、CD19与临床特征的相关性。方法采用三色流式细胞术对116例初诊MM病例进行免疫表型分析,并收集患者的实验室和临床指标。结果 116例MM均表达CD38,其他抗原CD19、CD138、CD56、CD20、CD33、CD117、CD45的阳性率分别为10.3%、96.6%、60.7%、3.4%、70.0%、25.6%、17.2%,无1例表达CD7、CD34。在116例MM中,胞浆κ轻链阳性率为34.5%,λ轻链阳性率为48.3%。CD45阳性患者分期较好,其表达缺失患者易出现骨破坏,微球蛋白、C反应蛋白水平较高;CD19表达与高分期有关,易出现贫血,微球蛋白、C反应蛋白水平较高。结论了解MM的免疫表型特点对此类疾病的诊断具有重要意义,其中CD45、CD19与分期等临床生物学特征有关,有助于判断预后。     

多参数流式细胞术测定多发性骨髓瘤细胞免疫标记的研究

本研究探讨多发性骨髓瘤(MM)的免疫表型特征及其意义。采用多参数流式细胞术直接免疫荧光技术,CD38/SSC设门,对33例MM患者及12例浆细胞反应性增多症患者的骨髓标本进行免疫分型检测,并辅以瘤细胞的形态学检查。结果表明:形态学检查观察到瘤细胞比例为6.0%-76.0%;流式细胞术CD38/SSC设门后可见到一群CD38强阳性细胞,比例为0.99%-57.54%;多数MM细胞表型为CD38st+CD138+CD19-CD56+(78.8%),部分患者伴有CD20(12.1%)、CD33(15.2%)、CD117(30.3%)、HLA-DR(9.1%)抗原表达,其余抗原表达均为阴性;27例(81.8%)MM患者检测到cκ或cλ的单克隆限制性,其余cκ及cλ均为阴性。结论:利用CD38/SSC设门方法的流式细胞术对MM进行免疫分型,根据细胞表面抗原的异质性,可鉴别良性或恶性浆细胞,为判断预后及靶向治疗提供依据。     

兰州地区多发性骨髓瘤患者M蛋白免疫固定电泳结果分析

目的 分析兰州地区多发性骨髓瘤患者M蛋白在年龄、性别方面的型别特征.方法 对兰州地区144例多发性骨髓瘤患者M蛋白进行免疫固定电泳分析.结果 从性别上看,男性发病率为女性的1.36倍,IgG-κ＞λ,IgA-λ＞κ;女性患者中IgG型和IgA型均为λ＞κ.发病年龄多为50～70岁,70～80岁次之,35岁以下未见,＞80岁者亦少见.结论 兰州地区多发性骨髓瘤发病在性别、M蛋白型别方面具有其特征.     

马法兰、泼尼松、沙利度胺一线治疗老年多发性骨髓瘤的临床分析

目的 探讨适合老年多发性骨髓瘤患者的一线治疗方案.方法 选取首次接受治疗的老年多发性骨髓瘤患者42例,随机分为治疗组(22例)和对照组(20例).治疗组给予马法兰+泼尼松+沙利度胺(MPT)方案,对照组给与沙利度胺+地塞米松(TD)方案,应用6个疗程后结束或改用其他方案.对两组临床疗效进行评价,并随访长期生存情况.结果 在MPT组,治疗后的IgG和IgA水平较治疗前明显下降,分别达到(12.58±2.33)g/L,(5.12±1.01)g/L,骨髓浆细胞数量明显减少(8.01±1.12)g/L、血红蛋白水平更接近正常值;上述指标与对照组比较差异均有统计学意义(P<0.05).MPT组的总有效率明显高于对照组(P<0.05).由两组的生存曲线可见,MPT组的5年生存情况亦好于对照组.不良反应评估中,MPT组未见明显异常,而对照组中可见沙利度胺的不良反应发生.结论 MPT方案可作为多数老年多发性骨髓瘤患者的最佳初始治疗方案.     

Cutaneous involvement in relapsed multiple myeloma

Cutaneous involvement in multiple myeloma with extramedullary disease is rare. We report the case of a refractory multiple myeloma patient who developed a cutaneous lesion. Histopathology revealed dermal immature plasma cell infiltrate with a lack of CD138 expression. This cutaneous location was associated with an aggressive clinical course and short survival.     

Monoclonal antibodies currently in Phase II and III trials for multiple myeloma

Introduction: Despite the introduction of novel agents, such as thalidomide, lenalidomide and bortezomib, multiple myeloma (MM) remains an incurable disease and new therapies are needed. mAbs are a new promising anticancer treatment option.

Areas covered: This review will focus on mAbs that are currently under evaluation in Phase II and III clinical trials, as single agent and in combination with established treatment options.

Expert opinion: mAbs are a new strategy against MM, and they have demonstrated encouraging results in preclinical models. mAbs have a relatively benign side-effect profile and work synergistically with traditional chemotherapies and with immunomodulatory drugs and proteasome inhibitors.     

血浆置换治疗多发性骨髓瘤的护理

目的总结血浆置换治疗多发性骨髓瘤的护理方法。方法2001年1月～2003年8月对5例多发性骨髓瘤病人进行了10次血浆置换治疗,治疗过程给予实施针对性的护理。结果病人血浆置换前骨痛剧烈,生活自理程度Ⅲ鄄Ⅳ级,置换后2d内清除病人血液中的M蛋白,血沉降低,血液黏稠度降低,骨痛明显缓解,生活自理程度均提高至Ⅱ级。结论护士熟练掌握血浆置换治疗的专业知识,并配合做好置换前后的护理是保证血浆置换顺利进行的基础。     

反应停治疗多发性骨髓瘤疗效的系统评价

目的 比较含沙利度胺(反应停)[反应停(+)]与不含反应停[反应停(-)]的化疗方案治疗多发性骨髓瘤(MM)疗效与安全性.方法 采用Cochrane系统评价方法,检索《中国期刊全文数据库》、《中国优秀博硕士论文全文数据库》、《中国重要会议论文全文数据库》、《中国图书全文数据库》、《中国引文数据库》、《万方医学期刊》(1994～2010年),井手工检索所有纳入文献的参考文献,纳入沙利度胺治疗多发性骨髓瘤的随机对照试验.评价纳入研究的方法学质量并进行资料提取后,采用RevMan 4.3软件进行Meta分析.结果 共鉴定并纳入7项随机对照试验研究共包括193例MM患者.目的均为比较含与不含反应停的化疗方案治疗多发性骨髓瘤的疗效和不良反应发生情况.分析结果显示,含与不含反应停的化疗方案治疗MM比较,针对降低M蛋白作用的结局指标差异有统计学意义(P＜0.05),Meta分析结果显示效应统计量OR及其95％CI为3.19(1.75～5.82).针对降低MM作用的结局指标数据差异有统计学意义(P＜0.05),Meta分析结果效应统计量OR及其95％CI为3.07(1.67～5.67).针对血红蛋白上升的结局指标差异有统计学意义(P＜0.05),Meta分析结果显示效应统计量OR及其95％CI为2.96(1.58～5.54).针对总有效率的结局指标数据差异有统计学意义(P＜0.05),Meta分析结果显示效应统计量OR及其95％ CI为3.54(1.83～6.81).结论 Meta分析结果提示,对于治疗MM疗效,反应停(+)组明显优于反应停(-)组.但需要更多大样本、高质量、双盲的随机对照试验予以证实.     

多发性骨髓瘤的误诊因素分析

多发性骨髓瘤(multiple myeloma,MM)是一种异质性的恶性浆细胞疾病,约占所有血液系统肿瘤的l0％左右.部分MM起病缓慢,临床表现可为骨痛、贫血、肾功能不全、感染、出血等,容易发生漏诊和误诊.及时正确的诊断MM对于后续治疗选择有重要意义,现就MM的误诊因素作一分析.     

硼替佐米致多发性骨髓瘤患者周围神经病变的研究进展

多发性骨髓瘤(MM)是一种常见的浆细胞恶性增殖性疾病,其发病率呈逐年增高趋势.硼替佐米(BTZ)是治疗MM的有效药物,广泛用于复发和新诊断MM患者.周围神经病变(PN)是BTZ的一种显著的具有剂量限制性的副作用,临床主要表现为麻木和感觉异常,PN发生时通常需要减少BTZ剂量,延迟或终止治疗方案,严重影响患者的生活质量....     

Cardiovascular complications of multiple myeloma in the elderly

Introduction: Multiple myeloma is a malignant neoplasm characterized by plasma cell proliferation in blood and bone marrow. Approximately two-thirds of the patients with multiple myeloma are >65 years at the time of diagnosis. Patients in this age group often have co-existing cardiovascular diseases.

Areas covered: The presence of multiple myeloma adds to the malady by direct deposition of amyloid protein in the heart or via toxicity of chemotherapeutic agents. Cardiac contractile dysfunction, arrhythmias and thromboembolic disorders are the main issues in the management of elderly patients with multiple myeloma.

Expert commentary: Assessment of cardiac risk and functional status requires careful evaluation by history, physical examination and imaging studies such as echocardiography and magnetic resonance imaging. The management of cardiovascular disorders in the presence of multiple myeloma is difficult and poses a challenge for the internist, the oncologist, and the cardiologist alike. This review is an overview of the problem of cardiovascular risk in and management of elderly patients with multiple myeloma.