多发性骨髓瘤形态学分型与临床特点及预后分析

<正>多发性骨髓瘤(MM)是以骨髓中单克隆性浆细胞增生异常和聚集为特征的恶性肿瘤,多见于60岁以上的老年人,约占恶性血液病的10%,异常浆细胞(瘤细胞)无限制地增生并浸润骨骼和软组织,引起骨痛及病理性骨折、贫血、感染、出血倾向、肾功能损害、高钙血症、淀粉样变等多种临床症状。本研究回顾分析了55例MM患者临床特点,并分析其与预后的关系,分析报道如下。     

多发性骨髓瘤细胞遗传学研究

目的探讨传统的细胞遗传学检测方法与荧光原位杂交(FISH)技术在多发性骨髓瘤(MM染色体异常检测中的应用价值。方法应用RHG显带技术对MM患者的骨髓标本进行染色体核型分析,观察MM患者细胞遗传学异常的检测率;应用一组探针(P53、RB1、D13S319、IGH、1q21)和FISH技术检测MM患者的染色体异常,观察异常检出率。结果对108例患者采用常规法检出20例染色体异常(18.5%),应用FISH技术检测出51例异常(47.2%),其中P53阳性6例(5.6%),RB1阳性的34例(31.5%),D13S319阳性的32例(29.6%),IGH阳性的22例(20.4%),1q21阳性的36例(33.3%),复杂核型的35例(32.4%)。结论 FISH在分析MM染色体异常方面是一种较为快速、准确和敏感的方法。     

多发性骨髓瘤预后因素和生存期评价的临床分析

目的：探讨多发性骨髓瘤（MM）预后因素及其生存期。方法：收集64例MM患者,应用Log—RafIk检验进行单因素分析,COX回归模型进行多因素分析MM预后因素,并比较DS分期和ISS分期间的生存率。结果：MM患者中出现高CRP、高β2M、低白蛋白、高龄和Ⅲ期提示预后不良。结论：MM患者的预后与CRP、β2M、白蛋白、年龄和分期有关。     

Phase II study of Fludarabine Phosphate in multiple myeloma

Summary Thirty-one patients with multiple myeloma refractory to therapy or relapsing after response to initial therapy were treated with Fludarabine Phosphate utilizing a daily intravenous schedule for five consecutive days. There were no objective responses seen and only one patient showed clinical improvement. Myelosuppression manifest as leucopenia and granulocytopenia was the primary toxicity seen. Fludarabine Phosphate is inactive in previously treated myeloma patients when given by the daily intravenous route. Address for offprints: Southwest Oncology Group (SWOG-8409), Operations Office, 5430 Fredericksburg Road, Suite #618, San Antonio, Texas 78229-6197, USA     

来那度胺在多发性骨髓瘤中的应用

来那度胺是新型免疫调节药物。国外研究显示来那度胺单药或联合其他抗骨髓瘤药物对初治或复发/难治多发性骨髓瘤(multiple myeloma,MM)均有较好的疗效。可以通过剂量调整用于治疗不同程度肾功能损害的骨髓瘤患者,并能使部分患者肾功能得到改善。继发性髓外病变通常提示预后较差,初步研究也提示来那度胺对这部分患者有一定的疗效。以来那度胺为基础的治疗同样也可以作为自体干细胞移植前的诱导治疗。     

来那度胺在多发性骨髓瘤治疗中的应用

多发性骨髓瘤目前仍是无法治愈的恶性血液系统疾病,复发、耐药、治疗相关毒性仍是阻碍患者生存的重要因素。来那度胺是新一代免疫调节剂,具有抗血管生成、改善免疫功能和肿瘤杀伤、改变骨髓微环境等独特的多重的作用机制。来那度胺在复发难治性多发性骨髓瘤的治疗中显著延长了无进展生存期(PFS)和总生存率。在新诊断的多发性骨髓瘤初始治疗中也获得了较高的缓解率。它在巩固维持治疗中更是显著延长了PFS和生存期,为长期"控制"多发性骨髓瘤提供了新的治疗策略。     

Thalidomide in multiple myeloma

Thalidomide (Thal) has antiangiogenic and immunomodulatory activity. Clinical research provided clear evidence that Thal is one of the most active drugs for the treatment of multiple myeloma leading to decrease of monoclonal protein of at least 50 % in 30 % of patients with relapsed or refractory multiple myeloma. Randomized trials based on a large body of evidence from phase II trials determined that Thal significantly increases total response rate in combination regimens (dexamethasone [Dex] and or chemotherapy) for relapsed as well as newly diagnosed patients. Thal also decreases time to response in combination therapy approaches. Thal has therefore been recognized by leading organizations as part of the treatment concept for patients with relapsed or refractory disease. Strict guidelines apply for the treatment and monitoring of Thal therapy to prevent the teratogenic effects of Thal and to monitor and prevent other potential adverse events as neuropathy and thrombosis. Additional randomized studies will now define the status of Thal for newly diagnosed patients and will be the basis for the approval in Europe and other countries world wide.     

Pharmacotherapy of multiple myeloma

Multiple myeloma is a malignant process of the plasma cell. There is no cure for this disease and at present the focus is to manage the disease as a chronic process to achieve a good quality of life. Hopefully, with the advancement in the understanding of the pathophysiology of the disease, target therapy should allow for the control of multiple myeloma, its prevention, and/or the reversal of organ damage; therefore prolonging survival. Proteasome inhibitors and immune modulators are the first of new therapies that target the malignant plasma cell microenvironment. In this review, different aspects of these agents are discussed.