多发性骨髓瘤患者血清骨桥蛋白及TNF-α检测的临床意义

目的探讨多发性骨髓瘤（MM）患者血清骨桥蛋白（OPN）和TNF-α检测的临床意义。方法采用酶联免疫吸附试验和放射免疫法测定MM患者血清OPN和TNF-α水平,比较不同病程、不同临床分期MM患者血清OPN和TNF-α水平的变化。结果初诊MM及复发患者血清OPN低于缓解期MM患者和对照组,TNF-α高于缓解期MM患者和对照组,差异有统计学意义（P均〈0.05）。Ⅰ～Ⅲ期MM患者血清OPN水平依次降低,TNF-α水平逐渐升高（P均〈0.05）。结论血清OPN和TNF-α检测可以作为MM预后以及疗效评判的指标。     

血清唾液酸水平在多发性骨髓瘤患者中的变化及其临床意义

目的:探讨不同分型多发性骨髓瘤(MM)患者血清唾液酸水平及其临床意义.方法:回顾性分析2013年1月1日-2019年10月31日青岛大学附属医院的175例MM患者,对其临床特点、实验室检查结果及预后进行统计学分析.结果:IgA型患者、轻链型患者唾液酸水平明显高于健康者(P＜0.05),而IgG型患者唾液酸水平与健康者比...     

多发性骨髓瘤患者血浆左旋肉碱含量变化及临床意义

目的探讨多发性骨髓瘤(multiple myeloma,MM)患者治疗前后血浆左旋肉碱含量及临床意义。方法选取10名正常人及36例MM患者(初诊21例,复发15例)。所有患者均接受含或不含蒽环类的方案化疗,采用高效液相色谱法检测患者及正常人的血浆左旋肉碱水平。结果无论初诊或复发患者的血浆左旋肉碱水平均低于正常人,化疗前复发患者组血浆左旋肉碱水平低于初治患者组,差异均具有统计学意义(P0.05);化疗后1 d及1周患者的血浆左旋肉碱水平均低于治疗前,含有蒽环类药物的方案可明显降低血浆左旋肉碱的水平,差异有统计学意义(P0.05)。结论化疗可导致MM患者的血浆左旋肉碱水平低下,化疗过程中补充左旋肉碱具有重要的意义。     

老年多发性骨髓瘤患者血清白细胞介素—2的检测及临床意义

目的检测老年多发性骨髓瘤（ＭＭ）患者血清白细胞介素－２（ＩＬ－２）含量，分析其临床意义。方法用固相放射免疫分析（ＲＩＡ）法检测４４例初诊老年ＭＭ患者、２０例健康老年人和４０例健康青中年人血清ＩＬ－２含量，随访患者３年的存活状况。结果ＭＭ患者血清ＩＬ－２为８．１１±２．５４μｇ／Ｌ，显著高于老年健康对照组的２．６８±０．６１μｇ／Ｌ（Ｐ＜０．０１）。血清ＩＬ－２≥５μｇ／Ｌ的患者３年生存率显著提高。血清ＩＬ－２与血清β２微球蛋白（β２－ＭＧ）有关，血清ＩＬ－２≥５μｇ／Ｌ的患者，β２－ＭＧ皆＜６ｍｇ／Ｌ。结论血清ＩＬ－２的检测可作为估计ＭＭ预后的一项指标。     

多发性骨髓瘤患者血清可溶性细胞间黏附分子-1水平检测及临床意义

目的探讨多发性骨髓瘤（MM）患者血清可溶性细胞间黏附分子-1（sICAM-1,CD54）水平的临床价值。方法采用酶联免疫吸附法（ELISA）测定多发性骨髓瘤患者治疗前后血清sICAM-1水平,并与同期健康体检者32例对照。结果对照组血清sICAM-1水平为（287±82）μg／L,MM患者治疗前血清sICAM-1水平为（374±101）μg／L,两组间差异有统计学意义（P〈0．05）。4个VAD方案化疗后缓解26例,其血清sICAM-1水平为（298±51）μg／L,与对照组比较差异无统计学意义（P〉0．05）;未缓解的12例患者血清sICAM-1水平为（3344±89）μg／L,与缓解MM患者比较差异有统计学意义（P〈0．05）。在观察期内有15例患者复发,其血清中sICAM-1水平为（352±113）μg／L,与缓解期比较差异有统计学意义（P〈0．05）。不同临床分期MM患者血清sICAM-1水平间差异有统计学意义（P〈0．05）;且Ⅲ期患者与Ⅰ期、Ⅱ期患者血清sICAM-1水平间差异均有统计学意义（P〈0．05）;Ⅰ期与Ⅱ期患者血清sICAM-1水平间差异均有统计学意义（P〈0．05）。结论血清sICAM—1水平的检测对多发性骨髓瘤患者的诊断、疗效判定及预后有一定帮助。     

16例多发性骨髓瘤患者的染色体分析

目的 :分析多发性骨髓瘤 (MM )细胞遗传学变化及其与MM的分型、分期及预后的关系。方法 :采用短期培养法及G显带技术对 16例MM患者进行细胞染色体核型分析 ,且对MM分型、分期及预后进行相关性分析。结果 :在 16例MM患者中发现染色体异常者 10例 (占 6 2 .5 % ) ,均有数目异常 ,表现有超二倍体、亚二倍体、多倍体及假二倍体 ;其中 9例发生于MMⅢ期 (占 5 6 .2 5 % ) ,1例发生于MMⅠ期 (占 6 .2 5 % ) ;4例为IgG型 ,3例轻链型 ,2例为IgA型 ,1例为不分泌型 ;有异常核型的MM患者表现为高 β2 微球蛋白 (β2 M )、高C反应蛋白(CRP)、低血红蛋白 (Hb)、低血小板 (PLT)、骨髓瘤细胞计数超过 30 % ;高Ca2 + 、高乳酸脱氢酶 (LDH) ,与无核型改变的MM患者比较差异有统计学意义 (P <0 .0 5 )。结论 :大多数MM患者存在染色体异常 ,且与临床分期及预后有关系 ,多发生于Ⅲ期 ,预后差 ,与其免疫分型无关     

老年多发性骨髓瘤患者临床特征分析

目的 探讨老年多发性骨髓瘤(MM)患者的临床特征.方法 选择复旦大学附属华东医院血液科2012年1月—2020年9月收治的84例MM患者,年龄49～89岁,平均(65.6±9.6)岁,中位发病年龄65.5岁.根据年龄将患者分为老年组(≥60岁,力=60)和非老年组(＜60岁,n=24),回顾性分析2组的一般资料、实验室...     

多发性骨髓瘤病人简单的预后模型

多发性骨髓瘤病人的生存时间差异很大 ,由于Ｍｅｔａ分析不能显示采取ＭＰ方案 (美法伦加泼尼松龙 )与更强烈的化疗方案其生存有差异。本文旨在分析评估诊断时可能的预后因素 ,从而协助医生确定治疗策略。方法　 1 974年 6月至 1 999年 1 2月共 1 1 6(男 63、女 53 )例多发性骨髓瘤病人进入研究 ,中位年龄 65( 3 6～ 97)岁。观察了诊断时 1 2个可能与预后有关的参数 ,即年龄、骨髓瘤细胞形态学、细胞核型、骨髓中浆细胞百分数、血红蛋白、血小板计数、血清白蛋白、肌酐、Ｃａ2 +、乳酸脱氢酶 (ＬＤＨ)、β2 -微球蛋白 ( β2 ＭＧ)、Ｃ反应…     

多发性骨髓瘤血清单克隆免疫球蛋白及IgG亚类检测

目的：探讨多发性骨髓瘤（MM）患者血清单克隆免疫球蛋白（M－蛋白）及IgG亚类的分布。方法：用免疫固定电泳对236例MM患者血清中M－蛋白进行免疫球蛋白重链及轻链定性分析,并用单扩散法对其中76例IgG型MM进行IgG亚类分析。结果：236例中,IgG型104例（44．07％）,IgA型60例（25．42％）,IdD型22例（9．32％）,轻链型47例（19．92％）,未分泌型3例（1．27％）。对其中76例IgG型MM研究发现：IgG161例（80．26％）,IgG26例（7．89％）,IgG1-IgG2双克隆1例（1．32％）,IgG3 8例（10．53％）,未见IgG4。结论：血清M－蛋白重链及轻链分类及IgG亚类的检测对MM的免疫分型、指导临床治疗及判断疾病预后具有一定的意义。     

多发性骨髓瘤患者血清肿瘤特异性生长因子水平及其临床意义

肿瘤特异性生长因子(TSGF)是目前研究较多的肿瘤生物学标志物，为恶性肿瘤形成及生长时促使肿瘤及周边毛细血管大量增殖的因子，其检测对恶性肿瘤的诊断及治疗有特异性指导意义。多发性骨髓瘤(MM)是一种血液系统恶性肿瘤，有关其TSGF的表达水平少见报道。2001年2月至2004年1月，我们对18例MM患者治疗前后的血清TSGF进行了检测，以探讨其表达特点及临床意义。     

Magnetic resonance imaging patterns in patients with multiple myeloma

Sixty-one consecutive patients with multiple myeloma were studied with magnetic resonance (MR) imaging of the spine. Sagittal T1-weighted and short inversion time (TI) inversion recovery (STIR) images were obtained. The MR patterns of the bone marrow were classified as diffuse (D) ( n  = 26), nodular (N) ( n  = 11), D + N ( n  = 13) or normal (n) ( n  = 11). Abnormal patterns were seen in 50 (82%) of the 61 patients. Correlations were found between the MR imaging patterns and some laboratory findings (WBC, haematocrit, platelet count, serum albumin, and percentage of marrow plasmacytosis). The survival of the patients with abnormal MRI patterns was significantly poorer than that of the patients with normal patterns. However, the survival of patients with a nodular pattern did not differ from those with a normal pattern. The MR imaging pattern of the bone marrow in patients with multiple myeloma is a useful factor in the assessment of prognosis.     

Sotatercept in patients with osteolytic lesions of multiple myeloma

This phase IIa study evaluated the safety and tolerability of sotatercept, and its effects on bone metabolism and haematopoiesis in newly diagnosed and relapsed multiple myeloma (MM) patients. Patients were randomized (4:1) to receive four 28‐d cycles of sotatercept (0·1, 0·3, or 0·5 mg/kg) or placebo. Patients also received six cycles of combination oral melphalan, prednisolone, and thalidomide (MPT). Thirty patients were enrolled; six received placebo and 24 received sotatercept. Overall, 25% of patients received all four sotatercept doses; 71% of sotatercept‐treated patients had ≥1 dose interruption mainly due to increases in haemoglobin levels. Grade ≥3 adverse events (AEs) were reported in 17% of patients receiving placebo and 58% receiving sotatercept. Grade 4 AEs in sotatercept‐treated patients were neutropenia, granulocytopenia, and atrial fibrillation (one patient each). In patients without bisphosphonate use, anabolic improvements in bone mineral density and in bone formation relative to placebo occurred, whereas bone resorption was minimally affected. Increases in haemoglobin levels, versus baseline, and the duration of the increases, were higher in the sotatercept‐treated patients, with a trend suggesting a dose‐related effect. Multiple doses of sotatercept plus MPT appear to be safe and generally well‐tolerated in MM patients.     

Prognostic value of serum markers of bone metabolism in untreated multiple myeloma patients

Bone involvement is a central feature of multiple myeloma (MM). We investigated whether serum markers of osteoblastic and osteoclastic activity correlate with the presence of bone disease and survival in 313 MM patients enrolled in a phase III trial (E9486). Five markers were measured, including osteocalcin (OC), carboxy-terminal propeptide of type I collagen (PICP), bone alkaline phosphatase (BAP), carboxy-terminal telopeptide of type I collagen (ICTP) and tartrate-resistant acid phosphatase (TRAP). We analysed the relationship between serum levels of these markers and the presence of bone manifestations, and survival. Serum levels of ICTP and BAP correlated significantly with bone pain, lesions and fractures. Serum level of ICTP was also higher in stage II-III compared with stage I disease. The serum level of ICTP was significantly associated with shortened survival in the univariate analysis. The median survival times were 4.1 and 3.5 years for low and high ICTP respectively (P = 0.02). There was a strong relationship between ICTP and beta-2-micrgolobulin (B2M). ICTP stands out as a significant marker of bone disease. Incorporation of these markers into clinical trials assessing the use of bisphosphonates in MM is needed to determine whether they might serve as indicators of effectiveness of these agents.     

Assessment of bone involvement in patients with multiple myeloma using bone densitometry

Abstract: To evaluate the use of dual energy X-ray absorptiometry (DXA) in multiple myeloma (MM) we performed a prospective study of 34 patients with newly diagnosed MM. Most patients had advanced disease and all but two patients had osteolytic bone destructions and/or pathological fractures. Bone mineral content (BMC) and bone mineral density (BMD) of the lumbar spine (L₁–L₄) and hip were measured using a Hologic QDR-1000 scanner. Collapsed vertebrae were not excluded from analysis. Data from 289 healthy Danish volunteers aged 21–79 yr were used for calculation of Z-scores. Lumbar spine BMC (Z-score –0.46±0.23, p=0.05) and lumbar spine BMD (Z-score –0.56±0.23, p=0.02) were significantly reduced in MM patients, whereas no reduction was seen in hip BMC or BMD. Collapsed vertebrae had marked reduced BMD (Z-score –1.34±0.22, p<0.001), as had non-fractured vertebrae in the same individuals (Z-score –1.42±0.25, p<0.001). Lumbar spine BMD correlated with radiologically assessed bone morbidity (r –0.37, p=0.03) and stronger with the incidence of vertebral fractures (r –0.64, p<0.001). Thus, osteopenia of the back is common in multiple myeloma and correlates with an increased incidence of fractures. DXA may identify subjects with increased risk of vertebral fractures for more intensive chemotherapeutic or anti-resorptive treatment.     

Substratification of patients with newly diagnosed standard-risk multiple myeloma

Despite the absence of high-risk cytogenetics and lower International Staging System (ISS) stages, a subset of patients with multiple myeloma (MM) experience poor overall survival (OS). We studied 1461 patients with newly diagnosed MM to identify patient and disease characteristics that predict a high-risk phenotype among standard-risk patients. Fifty-six percent of all patients presented with standard-risk disease. Among them, advanced age, extremes of body mass index, non-hyperdiploid karyotype and abnormal lymphocyte counts were associated with worse OS. Standard-risk patients with 0–1 of these adverse factors (hazard ratio [HR] 0·32, 95% confidence interval [CI] 0·24–0·43, P < 0·001) and 2 adverse factors (HR 0·54, 95% CI 0·41–0·72, P < 0·001) experienced better OS than high-risk patients. Two or more adverse factors were present in 17% of standard-risk patients and were associated with OS comparable to high-risk patients (HR 0·91, 95% CI 0·67–1·24, P = 0·548). Predictive power among standard-risk patients was improved using score groups compared to ISS stages. Patients with standard-risk MM are a heterogeneous group with one in six patients experiencing OS comparable to high-risk disease. Patients at risk can be identified using readily available patient and disease characteristics. These findings emphasize the importance of accurate risk stratification and help explain part of the heterogeneity observed in clinical practice.     

Ability of myeloma cells to secrete macrophage inflammatory protein (MIP)-1alpha and MIP-1beta correlates with lytic bone lesions in patients with multiple myeloma

Macrophage inflammatory protein (MIP)-1alpha and MIP-1beta have been identified as candidates for multiple myeloma (MM)-derived bone-resorbing factors. To validate the clinical relevance of these observations, we investigated correlations between the ability of MM cells to secrete these chemokines and the extent of MM bone lesions as well as levels of biochemical bone markers in patients with MM. Patients with multiple bone lesions exhibited higher MIP-1alpha and MIP-1beta secretion from MM cells along with elevated urinary deoxypyridinoline (Dpd), without significant elevation of serum bone-specific alkaline phosphatase (BALP) or osteocalcin compared with those with minimal bone lesions. MIP-1alpha and MIP-1beta levels correlated positively with urinary Dpd and serum BALP but not with serum osteocalcin. These results provide further evidence for a causal role of MIP-1alpha and MIP-1beta in the development of lytic bone lesions, and suggest that MM cells suppress osteoblastic bone formation to cause an imbalance of bone turnover and development of destructive bone lesions.     

Methylation status of fragile histidine triad (FHIT) gene and its clinical impact on prognosis of patients with multiple myeloma

Abstract:  Aberrant methylation of tumor suppressor genes (TSG) has been studied in multiple myeloma (MM). We determined the methylation status of the FHIT (fragile histidine triad) gene, a putative TSG, in 48 patients with MM. Clinical association with its methylation status was then analyzed. The FHIT gene methylation was observed in 21 of the 48 patients (44%). No association between FHIT gene methylation and clinical variables such as age, gender and clinical stage was found. However, the estimated 50% survival time of the methylated group was significantly shorter than that of the unmethylated group (18.2 vs. 45.1 months, P  < 0.05). Univariate analysis revealed adverse prognostic factors: FHIT gene methylation ( P  = 0.028), poor performance status (I to IV, P  = 0.002), anemia (≤8.5 g/dL, P  = 0.007), hypoalbuminemia (≤3.5 g/dL, P  < 0.002), high serum C-reactive protein levels (>0.5 mg/dL, P  = 0.002), elevated beta-2-microglobulin serum levels (>6.5 mg/L, P  < 0.001), and treatments not including autologous peripheral blood stem cell transplantation (auto-PBSCT) ( P  = 0.007). Multivariate analysis identified FHIT gene methylation [hazard ratio (HR) 1.722, 95% confidence interval (CI) 1.150–2.603, P  = 0.009], elevated beta-2-microglobulin serum levels (>6.5 mg/L, HR 2.005, 95% CI 1.035–3.937, P  = 0.004), and treatments not including auto-PBSCT are independent predictive variables. These findings indicate that aberrant methylation of the FHIT gene is an independent adverse prognostic factor in MM.