多发性骨髓瘤的发病与治疗的概况.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 * * * * * * Durie?Salmon系统基于以下四个因素： 血清或尿中M蛋白的数量 高水平M蛋白提示肿瘤负荷高 血钙数量 高血钙水平发生在进展性骨骼破环时 血中血红蛋白数量 低血红蛋白水平表明骨髓被骨髓瘤细胞代替，排挤正常红细胞前体细胞 溶骨性病变的数量 溶骨性病变的数量随疾病进展和肿瘤负荷增加而增加 * * * * Test Description Values indicating a more favorable prognosis Beta 2-microglobulin (?2-microglobulin or ?2-M) A protein normally found on the surface of cells; serum levels reflect the extent of disease 3 microg/mL Plasma cell labeling index (PCLI) The relative percentage of plasma cells actively growing; a low PCLI may indicate longer survival 1% C-reactive protein (CRP) Increased levels of this protein produced by the liver may indicate poorer prognosis 6 tg/mL Lactate dehydrogenase (LDH) Measures tumor-cell burden Age ≤60 y: 100-190 U/L Age 60 y: 110-210 U/L Plasmablastic morphology The general appearance of plasma cells; increased numbers of immature plasma cells (plasmablasts) indicates poor prognosis Absence of plasmablastic morphology Chromosome analysis (cytogenetic testing) Assesses the number and normalcy of chromosomes; for example, fluorescence in situ hybridization (FISH) is a test that detects abnormalities of specific chromosomes Normal chromosome 13 Bone marrow microvessel density (MVD) Measures the growth of new blood vessels (angiogenesis) in the bone marrow; increased MVD indicates poorer prognosis 6 vessels/field at 400x magnification * * * * * Bcl-2 suppresses apoptosis induced by a range of stimuli. Myeloma cells over express bcl-2 and so are resistant to apoptosis.