多发性骨髓瘤的发病与治疗概况教程.pptVIP

* * * * * Progression on or within 60 days of completing last therapy Median time to progression and survival decreases with number of prior therapies Mayo Clinic database (1985 – 1998), Blood 2002 Kumar et al. 44th Annual Meeting of the American Society of Hematology, 2002; Philadelphia, PA Abstract 2352 * * * * * * * MGUS Many workers consider this to be premalignant although many patients are stable and do not progress to myeloma. IgG in 75%, IgM in 15% and IgA in 10%. Approximately 25% of patients with MGUS develop plasma cell myeloma, primary amyloidosis, macroglobulinaemia, or other !ymphoproliferative disease after follow-up for more than 20 years. The actuarial risk of malignant transformation is unrelated to the type of M-protein. The median interval from the recognition of the M-protein to diagnosis of myeloma, macroglobulinaemia, or amyloidosis is approximately 10 years. Thus, patients with MGUS must be followed indefinitely for evidence of progressive disease. Smouldering myeloma These patients have higher levels of M-component and marrow plasmacytosis than patients with MGUS, and fulfil the minimal criteria for the diagnosis of plasma cell myeloma, but are asymptomatic and have no lytic bone lesions or other clinical features of rnyeloma, including anaemia, renal insufficiency, or hypercalcaemia, A small M-protein may be found in the urine and the concentration of normal serum immunoglobulins is often reduced. In some patients, symptomatic plasma cell myeloma does not develop for years. These patients are typically not treated unless progression occurs. Indolent Myeioma This variant is similar to smouldering myeloma in that the diagnostic criteria for plasma cell myeloma are met but differs from it in that the patients have up to three lytic bone lesions, without bone pain the M-protein is at intermediate levels like smouldering myeloma the patients have a normal Hb, serum calcium and creatinine there is no evidence of infection. As with smoldering