多发性骨髓瘤的免疫表型分析及预后价值的研究

目的 探讨初诊多发性骨髓瘤(multiple myeloma,MM)患者瘤细胞的免疫表型特征及其预后价值。 方法 应用流式细胞术,分析49例初诊MM患者瘤细胞的免疫表型,并搜集与患者预后相关的临床资料,进行统计分析。 结果 1)所有研究对象均可检测到骨髓瘤细胞,其表达CD45、CD38、CD138、CD19、CD56的阳性率依次为:8.16%、100%、89.80%、6.12%、42.86%;2)分析抗原表达与瘤细胞比例、β₂-MG、Hb、Alb、Ca等临床指标的关系,发现CD45阴性患者的β₂-MG水平高于CD45阳性患者(P＜0.05),CD19阴性患者的Hb和Alb水平低于CD19阳性患者(P＜0.05),CD56阴性患者的骨髓瘤细胞比例高于CD56阳性患者(P＜0.05),而CD138的表达与上述临床指标的水平无明显关系。 结论 多发性骨髓瘤免疫分型能有效地协助临床诊断,且CD45、CD19和CD56的缺失可能导致预后不良,对MM患者的治疗和预后评估具有重要价值。     

Bone lesions in multiple myeloma--the OPG/RANK-ligand system

Multiple myeloma has recently been found to induce considerable imbalance in the newly identified system of osteoprotegerin (OPG), receptor activator of nuclear factor KB ligand (RANKL) and RANK. The binding of RANKL to RANK on the surface of osteoclastic precursors in the presence of m-CSF activates the signalling pathways for differentiation and proliferation of an osteoclastic line. OPG is a decoy circulating receptor for RANKL which blocks its binding to RANK. There are at least three mechanisms by which myeloma cells affects the OPG/ RANKL/RANK system: 1: The adhesion between the myeloma / stromal cells and the osteoblastic precursors stimulates the system by increasing the production of RANKL. 2: Some myeloma lines produce independently membrane-bound or free RANKL. 3: The normal and mutated plasma cells bind, degrade and block the OPG production from the stromal cells. The OPG/RANKL/RANK system is the latest therapeutic target in the treatment of myeloma bone disease. The first results from the application of a synthetic analogue of OPG, as well as of RANKL antagonists or RANK inhibitors show decrease of the number of osteoclasts, osteolytic lesions and M-gradient.     

血清蛋白电泳对多发性骨髓瘤诊断的临床应用

目的：探讨血清蛋白电泳检测对多发性骨髓瘤（MM）的诊断价值。方法：对本院门诊及住院患者采用琼脂糖凝胶电泳法作血清蛋白电泳检测,检出M带的患者,再作免疫球蛋白G、A、M、轻链Kappa、Lambda、及Kappa/Lambda比值、总蛋白、球蛋白检测,并作回顾性分析。结果：12049例蛋白电泳检出M蛋白条带210例,占1.74%,其中确诊为MM的15例,占M蛋白血症的7.1%。血清Kappa测定结果：κ型多发性骨髓瘤显著高于健康组（P〈0.001）,λ型多发性骨髓瘤显著低于健康组（P〈0.001）,良性M蛋白病稍高于健康组（P〈0.05）。血清Lambda测定结果：κ型多发性骨髓瘤显著低于健康组（P〈0.001）,λ型多发性骨髓瘤显著高于健康组（P〈0.001）,良性M蛋白病稍低于健康组（P〈0.05）。血清κ/λ比值测定结果：κ型多发性骨髓瘤显著高于健康组（P〈0.001）,λ型多发性骨髓瘤显著低于健康组（P〈0.001）,良性M蛋白病与健康组相比（P〉0.05）,IgG、TP、GLB多发性骨髓瘤显著高于良性M蛋白病组（P〈0.001）。结论：血清蛋白电泳中M蛋白的检查是早期发现多发性骨髓瘤的敏感方法。     

趋化因子与多发性骨髓瘤疗效及预后关系的研究

01);化疗无效患者骨髓血浆中MIP-1a、SDF-1a、MCP-1、IL-8的水平化疗前后比较,差异无统计学意义(P>0.05).结论 趋化因子MIP-1a、SDF-1a、MCP-1、IL-8可以作为MM疗效和预后判断的指标.     

多发性骨髓瘤治疗的现状和未来

人类认识多发性骨髓瘤(multiple myeloma, MM) 已经有一个半世纪的历史.150多年以来,MM的治疗取得了不少的进展.20世纪60年代,美发仑被引入MM的治疗并作为MM的一线治疗方案一直沿用至今,但有效率仅为40%～50%,完全缓解(CR)率仅为5%.20世纪90年代,大剂量化疗联合造血干细胞移植使MM治疗有效率和CR率分别达到80%和50%.但即使是获得CR的患者,大部分将在数年内复发.迄今为止,MM仍然是一种不可治愈的疾病.近年来,随着对MM生物学特性的认识的深化,许多新的治疗MM的方法也已经或即将应用于临床.本文将在回顾MM治疗现状的基础上,介绍这一领域的最新进展,希望能对MM的治疗有所裨益.     

Assessment of observer variation in measuring the Radiographic Vertebral Index in patients with multiple myeloma

The Radiographic Vertebral Index (RVI) was assessed as a possible outcome measure for bone disease in myeloma by evaluating within and between reader reproducibility. Four readers (2 radiologists and 2 clinical hematologists) independently scored, on two separate occasions, the RVI on 40 radiographs from patients with myeloma. Each vertebra from third thoracic (T3) to fifth lumbar (L5) received a score of "1" if normal, "2" if biconcave and "4" if crushed or fractured. RVI global scores, therefore, could vary from a minimum of 15, for no damage, to a potential maximum of 60 in which all vertebrae are collapsed. Agreement was determined for each vertebra using crude percentage agreement and the kappa statistic (which corrects for chance-expected agreement) for categorical data, and for global score using analysis of variance and calculating intra-class correlation. With increasing mean abnormality score on individual vertebrae there was a corresponding increase in kappa and reduction in crude percentage agreement. Within readers, the mean percentage agreement across all vertebrae varied from 85.6 to 90.3% and the observed differences just reach statistical significance (p = 0.048). Mean kappa values ranged from 0.48 to 0.63 and were similar across readers. Differences in intra-reader agreement were not related to subspecialty. When between reader percentage agreement and kappa scores were assessed for radiologists and non-radiologist clinicians, no difference could be detected. Agreement with respect to intra-reader mean global RVI scores was excellent as illustrated by the intra-class correlation coefficient which varied from 0.89 to 0.94. The mean intra-class correlation for radiologists was 0.92, compared with 0.91 for non-radiologists.(ABSTRACT TRUNCATED AT 250 WORDS)     

多发性骨髓瘤老年患者化疗后感染因素分析与对预后的影响

目的探讨初治多发性骨髓瘤(MM)老年患者化疗后感染的临床特点、易感因素及对预后的影响,以降低感染率。方法对2000年2月-2013年3月85例初治老年MM患者化疗后感染的临床资料进行回顾性分析,所有数据采用SPSS 13.0软件进行统计分析。结果患者化疗后感染45例,感染率为52.9%;64.4%的感染发生于第一个疗程后,PD方案与传统化疗方案相比感染率差异无统计学意义;感染部位以呼吸道感染最多见;36例患者检出病原菌52株,其中革兰阴性杆菌占44.2%、革兰阳性球菌占19.2%、真菌占36.6%;肾功能不全、低白蛋白血症、粒细胞减少、ECOG评分≥3分为感染的易感因素。结论老年多发性骨髓瘤患者是化疗后感染的高危人群,感染后生存期短、早期病死率高,化疗期间需加强免疫保护。     

Management of multiple myeloma

This article reviews the diagnostic approach to a patient with suspected multiple myeloma. Studies of chemotherapeutic regimens are reviewed and the alternative therapeutic options available at different stages of disease progression are discussed. These include newer modalities of treatment such as hemi-body irradiation as second-line therapy, bone marrow transplantation in plateau-phase and the role of alpha interferon.     

Plasma electrolytes in multiple myeloma

The plasma cell myeloma (multiple myeloma, myelomatosis) is a progressive disease, characterized by bone marrow plasmacytomas and the presence of monoclonal antibodies (IgG, IgA, IgD, IgE), or free kappa or lambda immunoglobulin side chains. The monoclonal antibodies or Bence-Jones protein may precipitate in the tubuli and impair kidney function. In addition, the plasma protein concentration may increase at the expense of plasma water level causing unrealistically low electrolyte levels. Since the isoelectric points of immunoglobulins are higher than those of most other plasma proteins, the net charge of plasma proteins may change causing new electrolyte balance. In addition, some monoclonal antibodies are more hydrated than others, and their high concentration may cause not only increased plasma viscosity but further electrolyte imbalance. In the present work the relationship between plasma protein and electrolyte levels is studied in samples of 100 multiple myeloma patients.     

Palmar-plantar fasciitis and multiple myeloma

Palmar fasciitis and arthritis was reported in association with several neoplasms and in particular with the cancers of the ovary. We report the case of a 37 year old patient who was hospitalized in our service for investigation of sever palmar fasciitis and to whom various investigations allowed to make the diagnosis of a light chains myeloma. Through the study of the various cases of the literature, we remind the various characteristics of this syndrome.     

Meta-analyses of multiple myeloma and farming

A series of meta-analyses of peer-reviewed studies of multiple myeloma (MM) and farming were performed, using 32 studies published between 1981 and 1996. Prior to the meta-analyses, all studies were reviewed and evaluated for heterogeneity and publication bias. A random-effects meta-analysis including all of the studies yielded an estimator of relative risk equal to 1.23, with a 95% confidence interval (95%CI) of 1.14, 1.32. The estimator of relative risk obtained from a meta-analysis restricted to female farmers was 1.23 (95%CI = 1.17, 1.29). A third meta-analysis restricted to studies of farmers residing in the central United States resulted in an estimator of relative risk equal to 1.38 (95%CI = 1.27, 1.51). These findings were not influenced by either a publication bias or a specific study design. The consistent significant positive findings suggest that there is an association between MM and farming. Exposures commonly experienced by farmers and that might contribute to the occurrence of MM include infectious microorganisms, solvents and pesticides. Am. J. Ind. Med. 32:510–516, 1997. © 1997 Wiley-Liss, Inc.     

Renal complications of multiple myeloma

In connection with the analyses of 84 post-mortem examinations (47 men, 37 women, average age: 66.3 years) the author dealt with the renal complications of multiple myeloma. The signs of cylinder nephropathy, light-chain nephropathy, amyloidosis, nephrocalcinosis, urate nephropathy, acute renal insufficiency, renal vein thrombosis, acute and chronic pyelonephritis as well as the tumorous infiltration of the renal tissue have been sought for. The severity of the lesions were ranged into minimal, slight, moderate, and severe groups. On the basis of the semiquantitative morphological picture and the clinical data: 1. intact kidney (41 patients), 2. involvement of the kidney without azotemia (10 patients), 3. involvement of the kidney with azotemia (17 patients, serum creatinine level: greater than 177 mumol/l) and 4. renal involvement with chronic renal insufficiency associated with uremia (16 patients) were discerned. In the background of 33 cases (39%) with deteriorated renal function cylinder nephropathy was found most frequently (27 occasions) (32%). Every other complication occurred significantly less frequently e.g. amyloidosis or kappa-light-chain nephropathy occurred in 3 cases each.