Multiple Myeloma and Other Plasma Cell Neoplasms多发性骨髓瘤和其他浆细胞肿瘤.docVIP

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Multiple Myeloma and Other Plasma Cell Neoplasms多发性骨髓瘤和其他浆细胞肿瘤.doc

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Multiple Myeloma and Other Plasma Cell Neoplasms多发性骨髓瘤和其他浆细胞肿瘤.doc

Multiple Myeloma and Other Plasma Cell Neoplasms General Information Cellular Classification Stage Information Multiple myeloma Stage I multiple myeloma Stage II multiple myeloma Stage III multiple myeloma Isolated plasmacytoma of bone Extramedullary plasmacytoma Macroglobulinemia Monoclonal gammopathy of undetermined significance Treatment Option Overview Multiple Myeloma Conventional chemotherapy treatment options High-dose chemotherapy options for symptomatic myeloma Isolated Plasmacytoma of Bone Extramedullary Plasmacytoma Waldenstr?ms Macroglobulinemia (Lymphoplasmacytic Lymphoma) Monoclonal Gammopathy of Undetermined Significance Refractory Plasma Cell Neoplasm Changes to This Summary (02/20/2003) General Information Multiple myeloma is a systemic malignancy of plasma cells that is highly treatable but rarely curable. It is potentially curable when it presents as a solitary plasmacytoma of bone or as an extramedullary plasmacytoma. The median survival in the prechemotherapy era was about 7 months. After the introduction of chemotherapy, prognosis improved significantly with median survival of 24 to 30 months and a 10-year survival of 3%. The disease is staged by estimating the myeloma tumor cell mass on the basis of the amount of monoclonal (or myeloma) protein (M-protein) in the serum and/or urine, along with various clinical parameters, such as the hemoglobin and serum calcium concentrations, the number of lytic bone lesions, and the presence or absence of renal failure. The stage of the disease at presentation is a strong determinant of survival, but has little influence on the choice of therapy since almost all patients (except for rare patients with solitary bone tumors or extramedullary plasmacytomas) have generalized disease. Treatment selection is influenced by the age and general health of the patient, prior therapy, and the presence of complications of the disease.[1-3] The initial approach to the patient is to establish the diagnosis by: