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老年人多发性骨髓瘤肾病的诊治
多发性骨髓瘤(multiple myeloma,MM)是浆细胞系异常增生的恶性疾病.MM主要浸润骨髓和软组织,它能产生异常的单克隆免疫球蛋白,引起骨骼破坏、贫血、肾功能损害和免疫功能异常.骨髓瘤肾病是MM常见和严重的并发症,又被称为管型肾病(cast nephropathy,CN).
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重视多发性骨髓瘤的规范化诊治
多发性骨髓瘤(MM)是血液系统常见的恶性肿瘤,多好发于老年患者,在许多国家均是发病率第二位的血液恶性肿瘤,约占血液恶性肿瘤的10%[1].骨髓瘤细胞生长相对较为缓慢,但MM患者并不像急性白血病(AL)容易缓解,AL的首次化疗后的完全缓解(CR)率可以达到.
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重视多发性骨髓瘤的临床研究
多发性骨髓瘤(MM)是一种浆细胞克隆性恶性增生性疾病,好发于中老年人,约占血液系统恶性肿瘤的10%,占所有恶性肿瘤的1%,是继淋巴瘤之后第二多发的血液系统肿瘤(发病率高于白血病).美国2006年新诊断MM病例16570例,死亡11310例[1].在我国,随着医疗诊断水平的不断提高和人口的老龄化,发病率也逐年增加.本病早期,临床症状不明显,多数患者在初次诊断时病情已至中晚期,给治疗带来一定的困难.当前仍认为MM是一种不可治愈的疾病,诊断后的中位生存时间大约为3年,传统的常规化疗5年生存率约为29%[2].当患者对现有治疗表现为难治、耐药时,终死亡.因此,努力提高本病的诊断水平,深刻认识疾病的临床过程,积极研究合理的治疗方法,是延长生存期,减少并发症,改善预后的主要途径.
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多发性骨髓瘤肾损伤诊治专家共识
Renal impairment (RI) is a common complication of multiple myeloma (MM), whichis presented as chronic kidney disease (CKD) or acute kidney injury (AKI).The typical pathologicalfeature is cast nephropathy.Presently international system staging (ISS) is used in evaluating MM.Althoughthe classic Durie-Salmon staging system could be still used in clinical practice , it may miss out some patientswith renal impairment.For evaluations of RI in MM patients with CKD, it′s recommended to assess theestimated glomerular filtration rate (eGFR) by creatinine based formula CKD-epidemiology collaboration(EPI) or modification of diet in renal disease (MDRD) and to stage the renal injuries according to 2013Kidney Disease Improving Global Outcomes (KDIGO) CKD guidelines.For MM patients with AKI, KDIGOAKI guidelines is recommended for evaluation.Renal biopsy is not a routine procedure in all MM patients .It′s necessary for patients presenting with glomerular injuries such as albuminuria >1 g/24 h to eliminateimmunoglobulin associated amyloidosis (AL) and monoclonal immunoglobulin deposition disease (MIDD).The effective treatment of MM can reduce serum light chain concentration and improve renal function .Thebasis of the RI treatment in MM is bortizomib-based regimen, which does not require dosage adjustment inpatients with dialysis or renal insufficiency.Thalidomide and lenalidomide are two major immunomodulatorsin MM treatment.Thalidomide can be used effectively in RI patients without dosage adjustment whilelenalidomide should be used cautiously in patients with mild or moderate RI with dosage adjustment andserum toxicity surveillance. High-dose therapy ( HDT) and autologous peripheral blood stem celltransplantation (APBSCT) can be therapeutical options for RI patients younger than 65 y, and they shouldbe considered more prudently in patients with severe renal insufficiency (GFR <30 ml/min).For patientswho are not suitable for the treatment mentioned above , they can be treated with conventional chemotherapy ,including VAD (vincristine, adriamycin and dexamethasone ), MP (mephalan and prednisolone) and highdosedexamethasone regimen.Adequate hydration (at least 3 litres of fluid intake a day or 2 L· m-2 · d-1 )and correcting reversible causes of RI are key points for the supportive care .Renal replacement therapy(more often hemodialysis) should be started in patients with severe AKI and end stage renal disease(ESRD).High flux or high cut-off membrane are recommended because routine hemodialysis could notremove the serum free light chain (sFLC) effectively.Plasmapheresis (PE) is recommended for patientswith hyperviscosity syndrome or cast nephropathy presented with AKI , which may help to increase thedialysis-independency.
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中国多发性骨髓瘤诊治指南(2017年修订)
Multiple myeloma ( MM) is a clonal plasma cell malignancy , mainly in elderly people and still incurable at present .In the ear of novel agents and sensitive laboratory exams , the diagnosis and treatment of MM have been significantly improved .Chinese MM guidelines for the diagnosis and treatment were updated every two years according to the progression of international and domestic research and clinical studies.In this version, we updated the response criteria and new combination regimens in newly diagnosed patients.Monoclonal gammopathy of renal significance ( MGRS) was added as a new part of differential diagnosis, meanwhile, relapsed/refractory MM patients should be treated as long as possible .
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Objective.To investigate the frequency of p16 and p15 gene methylation in multiple myeloma (MM),and its relationship with bone marrow cell apoptosis and clinical outcome.Methods.Twenty two patients with MM were studied to detect p16 and p15 gene methylation.Methylation specific polymerase chain reaction (MSP) was used to detect gene methylation,and terminal transferase mediated dUTP nick end labeling (TUNEL) was used to detect cell apoptosis.Results.p16 and /or p15 gene methylatoin was detected in 10 of 22 patients (45.4%).There were 3 patients with p16 gene methylation,9 patients with p15 gene methylation,and 2 patients with both genes methylation.The incidence of methylation of p15 gene was higher than that of p16 gene (P< 0.05).The patients with p16 and/or p15 gene methylation had a delayed cell apoptosis,poor response to chemotherapy,and a short overall survival (OS).Conclusion.The methylation of p16 and/or p15 gene plays a key role in MM apoptosis pathogenesis.The patients with both p16 and p15 gene methylation had a poor prognosis.
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硼替佐米为主方案治疗多发性骨髓瘤患者的临床研究
目前多发性骨髓瘤(MM)常用的化疗方案有MP(马法兰+泼尼松)、VAD(长春新碱、阿霉素及地塞米松)等,但上述方案治疗起效慢,完全缓解率低,反应持续时间短[1],临床疗效不尽人意.2009年美国国家综合癌症网(National Comprehensive Cancer Network,NCCN)MM诊治指南中将硼替佐米推荐为MM的一线用药[2].近年来多项研究发现其在MM的治疗中取得了较好的疗效[3-4].为了进一步观察硼替佐米治疗MM患者的疗效,我们将39例MM患者治疗的结果报道如下.
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多发性骨髓瘤的诊治思路
多发性骨髓瘤为发生于B淋巴细胞的恶性浆细胞病.好发于中老年,但近年其发病率有增高及发病年龄有提前的趋势.病因与发病机制不清楚.可能与电离辐射、慢性抗原刺激、EB病毒或卡氏肉瘤相关的疱疹病毒(HHV-8)感染诱发C-MYC、N-RAS、K-RAS或H-RAS等癌基因高表达有关,也可能与一些细胞因子有关.IL-6为多发性骨髓瘤的生长和分化因子.溶骨性病变的发生可能与IL-1、IL-6、TNF等溶骨因子有关[1].
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万珂治疗多发性骨髓瘤致胃肠道反应的观察与护理
多发性骨髓瘤(multiple myeloma,MM)是浆细胞病中常见的一种类型.在血液系统肿瘤中占10%~15%,已超过急性白血病仅次于非霍奇金淋巴瘤居第2位,好发于中老年人,40岁以下仅占2%,男女比例为(1.6~3.0)∶1[1].随着人口老龄化,其发病率也有所增加.联合化疗甚至造血干细胞移植,虽然对MM的缓解率和生存期有所改善,但终出现复发并对化疗产生耐药.万珂(硼替佐米)是一种经过修饰的双太基硼酸,可逆性抑制26S蛋白酶体样活性,阻止泛素化蛋白质降解.
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1例多发性骨髓瘤病人血型变异的临床分析与护理
血型具有遗传性,受控于9号染色体上的一组复等位基因,一般认为一个人的血型终生不变,但在某些白血病及恶性肿瘤的影响下可出现ABO血型抗原性减弱,导致血型变异[1],国内外均有报道.多发性骨髓瘤出现血型变异,在临床上较少见,现报道1例.1病例介绍病人,中年男性,主因腰背部疼痛不适、四肢无力2月余,我科骨髓穿刺检查确诊为多发性骨髓瘤,于2010年8月入院,先后行TAD(沙利度胺+吡柔比星+地塞米松)方案化疗3次,期间出现贫血症状,血型检测为AB型,顺利输入约800mL的AB型浓缩红细胞.
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三氧化二砷与维生素C治疗多发性骨髓瘤骨折病人的副反应观察
多发性骨髓瘤(MM)是B淋巴细胞恶性肿瘤,发病率居血液恶性肿瘤第二位,其常见并发症是骨折,治疗以化疗和干细胞移植为主,但缓解率低,难治性、复发性病例缓解率更低.近年来,国外采用三氧化二砷(As2O3)联合维生素C治疗MM有一定疗效[1].我们观察了As2O3联合维生素C治疗难治性或复发性MM病人35例的副反应.现报告如下.
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多发性骨髓瘤的诊断与鉴别诊断
多发性骨髓瘤(MM)是骨髓浆细胞恶性疾病.在美国其发病率为3/10万,已超过白血病,仅次于淋巴瘤,居血液恶性疾病的第2位.
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靶向药物治疗老年多发性骨髓瘤的新进展
多发性骨髓瘤(MM)是一种单克隆的浆细胞异常增生的恶性肿瘤,世界范围内年发病率为1~5/10万,西方国家发病率较高[1].我国年发病率1/10万,发病以50~70岁居多,平均发病年龄62岁[2].
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纯化CD34+造血干细胞治疗多发性骨髓瘤的进展
多发性骨髓瘤(MM)是一种克隆增殖性疾病,占血液系统肿瘤的10%,全身恶性肿瘤的1%.主要病理特征是异常浆细胞浸润骨骼和软组织,产生M蛋白,引起骨骼破坏,贫血,肾功能损坏和免疫功能异常.此病多发于中老年,男性多见.近年来随着人口的老龄化,MM的发病有逐年递增的趋势[1,2].
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免疫固定电泳技术对多发性骨髓瘤的诊断价值
多发性骨髓瘤(multiple myeloma,MM)是以浆细胞异常增生为特征的一种恶性肿瘤性疾病.瘤细胞分泌大量单克隆免疫球蛋白(M蛋白)于血中,同时正常多克隆免疫球蛋白合成受到抑制使机体免疫力减低,从而引起多组织器官功能障碍.多发性骨髓瘤的临床表现多种多样,骨髓细胞学、X线、免疫球蛋白和血清蛋白的定量检测等是诊断MM的重要方法,但这些方法特异性欠佳,可能对部分无症状或临床症状不典型的患者造成漏诊或误诊.而免疫固定电泳的应用则使MM的诊断及分型更趋完善,可及时纠正临床的误诊和漏诊.我们对91例MM患者进行免疫球蛋白定量、轻链定量,再进行血清蛋白电泳和血清免疫固定电泳检测,现将结果报告如下.
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系统性红斑狼疮并发多发性骨髓瘤一例
患者,女,55岁,8年前出现双手背暗红色皮疹,经当地诊治但无好转;7年前出现面部红斑,日晒后加重,经当地抗过敏治疗无好转,后出现关节痛伴发热.为进一步治疗于2002年10月31日入我院皮肤科.高血压病史15年.体检:面部可见暗红色斑疹及典型蝶形红斑,双手背暗红色斑疹.实验室检查:ANA(+),ds-DNA(+),Sm(+).诊断:系统性红斑狼疮;高血压病2级,中危组.予泼尼松治疗3周好转出院,渐减量至5 mg qd维持,病情平稳.2006年11月3日出现乏力、关节痛,查ANA(+),ds-DNA(+),尿蛋白2+,于11月17日再次入院.
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并发肾淀粉样变的多发性骨髓瘤一例
多发性骨髓瘤(MM)是骨髓内浆细胞克隆性增殖引起的恶性肿瘤.肾损害是MM常见的继发性脏器损害之一,而MM并发肾淀粉样变并不多见.患者,男,57岁,因反复双下肢水肿伴吞咽困难半年,再发5 d入院.患者于2008年12月无明显诱因出现双下肢水肿,并逐渐出现吞咽困难,伴肢体乏力、活动明显受限、双手指麻木,全身大关节疼痛,无晨僵及关节红肿,每晚夜尿4~5次.
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多发性骨髓瘤的放射学诊断
关键词: 多发性骨髓瘤 放射学诊断 multiple myeloma -
多发性骨髓瘤国际统一疗效标准解读
近年来,国际骨髓瘤工作组(international myeloma workgroup,IMWG)制定了多发性骨髓瘤(multiple myeloma,MM)新的诊断标准以及新的分期系统(ISS),并已得到广泛临床应用.近,新的MM疗效标准也已面世,MM新的国际统一疗效标准(international uniform response of criteria for multiple myeloma)[1]以EBMT标准为主要蓝本,在此基础上作了大量的修订、补充和完善,统一了疗效标准,使之既贴近临床工作实际,又便于开展国际合作与交流.