multiple myeloma and other plasma cell neoplasms多发性骨髓瘤和其他浆细胞肿瘤

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1、MultipleMyelomaandOtherPlasmaCellNeoplasms·GeneralInformation·CellularClassification·StageInformationoMultiplemyeloma§StageImultiplemyeloma§StageIImultiplemyeloma§StageIIImultiplemyelomaoIsolatedplasmacytomaofboneoExtramedullaryplasmacytomaoMacroglob

2、ulinemiaoMonoclonalgammopathyofundeterminedsignificance·TreatmentOptionOverview·MultipleMyelomaoConventionalchemotherapytreatmentoptionsoHigh-dosechemotherapyoptionsforsymptomaticmyeloma·IsolatedPlasmacytomaofBone·ExtramedullaryPlasmacytoma·Waldenstr

3、öm'sMacroglobulinemia(LymphoplasmacyticLymphoma)·MonoclonalGammopathyofUndeterminedSignificance·RefractoryPlasmaCellNeoplasm·ChangestoThisSummary(02/20/2003)GeneralInformationMultiplemyelomaisasystemicmalignancyofplasmacellsthatishighlytreatablebutra

4、relycurable.Itispotentiallycurablewhenitpresentsasasolitaryplasmacytomaofboneorasanextramedullaryplasmacytoma.Themediansurvivalintheprechemotherapyerawasabout7months.Aftertheintroductionofchemotherapy,prognosisimprovedsignificantlywithmediansurvivalo

5、f24to30monthsanda10-yearsurvivalof3%.Thediseaseisstagedbyestimatingthemyelomatumorcellmassonthebasisoftheamountofmonoclonal(ormyeloma)protein(M-protein)intheserumand/orurine,alongwithvariousclinicalparameters,suchasthehemoglobinandserumcalciumconcent

6、rations,thenumberoflyticbonelesions,andthepresenceorabsenceofrenalfailure.Thestageofthediseaseatpresentationisastrongdeterminantofsurvival,buthaslittleinfluenceonthechoiceoftherapysincealmostallpatients(exceptforrarepatientswithsolitarybonetumorsorex

7、tramedullaryplasmacytomas)havegeneralizeddisease.Treatmentselectionisinfluencedbytheageandgeneralhealthofthepatient,priortherapy,andthepresenceofcomplicationsofthedisease.[1-3]Theinitialapproachtothepatientistoestablishthediagnosisby:1.DetectionofanM

8、-proteinintheserumorurine.2.Detectionofmorethan10%plasmacellsonabonemarrowexamination.3.Detectionoflyticbonelesionsorgeneralizedosteoporosisinskeletalx-rays.1.Presenceofsofttissueplasmacytomas.References1.BatailleR,HarousseauJL:Multiplemyeloma.NEnglJ