多发性骨髓瘤患者M蛋白标记的临床意义

目的:探讨多发性骨髓瘤（multiple myeloma,MM）患者血清蛋白电泳M蛋白标记的临床意义,观察其定量水平监测疾病进展和评估治疗药物的疗效。方法:对169例患者血清蛋白电泳的M蛋白波峰进行柱状法标记,通过免疫固定电泳(IFE)确诊其免疫分型,同时进行血清总蛋白（TP）、白蛋白(ALB)含量检测。连续追踪25例初诊诊断为MM患者的血清蛋白电泳,将M蛋白波峰标记得到M 蛋白百分比,换算M 蛋白浓度。换算公式:M 蛋白浓度（g/L）=TP浓度（g/L）×M蛋白百分比（%）,将计算结果进行对比。结果:在169例患者中,血清蛋白电泳β区见M蛋白波峰49例（29.0%）、γ区见M蛋白波峰120例（71.0%）,经过IFE分型:κ型IgG 型48例(28.4%),λ型IgG型43例(25.4%);κ型IgA型14例(8.3%),λ型IgA型16例(9.5%);κ型IgM 11例(6.5%),λ型IgM 3例(1.8%);κ型IgD型 2例(1.2%),λ型IgD型6例(3.6%); 游离κ轻链型2例(1.2%),游离λ轻链型8例(4.7%);双克隆型 1例(0.6%);未见单克隆条带15例(8.9%)。随访和监测25例MM患者化疗疗效评估:化疗后较化疗前白蛋白明显升高;其中β区M蛋白4例,β球蛋白及M蛋白浓度明显降低,差异均有统计学意义（P＜0.05）;γ区M蛋白21例,γ球蛋白及M蛋白显著降低（P＜0.05、P＜0.01）,其中M蛋白持续存在的MM患者,第1次评估血清TP含量和M 蛋白浓度明显下降、ALB含量明显升高,第2次评估TP、ALB含量在正常参考值区间,趋于平稳,M 蛋白浓度逐渐下降,可至消失。结论:血清蛋白电泳M蛋白的标记是诊断MM、巨球蛋白血症、淀粉样变等浆细胞病的依据,可作为标志物对其定量,更好的为监测疾病进展和评估治疗药物的疗效提供指导。     

血清游离轻链在多发性骨髓瘤中的临床诊断研究

目的 探讨血清游离轻链(sFLC)在多发性骨髓瘤(MM)中的临床诊断价值.方法 收集初诊MM患者96例作为研究组,另收取同时期进行体检的健康人群45例作为对照组.采用免疫比浊法检测sFLC-κ及sFLC-λ,并计算sFLC-κ/λ比值.结果 对96例MM患者使用IFE进行M蛋白分型,结果显示,IgG型患者人数最多.κ-MM组患者sFLC-κ、sFLC-κ/λ水平明显高于对照组,λ-MM组患者sFLC-κ、sFLC-λ水平明显高于对照组,sFLC-κ/λ明显低于对照组,差异有统计学意义(P＜0.05).sFLC-κ/λ比率高患者与低比率患者ISS国际分期存在明显差别(P＜0.05).结论 sFLC的检测对于MM的临床诊断有积极的意义,sFLC-κ/λ与MM分期具有相关性.     

淋巴组织肿瘤伴M蛋白血症二例

 目的　分析淋巴组织肿瘤伴M蛋白血症病例的临床及病理特点、诊断和治疗。方法　对1例弥漫小B细胞淋巴瘤（B-SLL）伴单克隆IgM升高,1例慢性淋巴细胞白血病（CLL）伴单克隆IgG升高的病例进行分析及文献复习。结果　B-SLL和CLL可伴有M蛋白血症,且单克隆IgM可高达53.90 g／L,单克隆IgG可高达71.60 g／L。氟达拉滨是治疗B-SLL和CLL有效的药物,临床应用疗效好且无明显毒副作用。结论　对原因不明的M蛋白血症伴发热、淋巴结肿大的患者,应警惕B淋巴细胞肿瘤的可能,早期行骨髓穿刺和（或）淋巴结活检有助于明确诊断。     

IgG-2κ轻链型多发性骨髓瘤三例临床和实验室特征

目的 探讨IgG-2κ轻链型多发性骨髓瘤(MM)的临床和实验室特征.方法 结合相关文献分析3例IgG-2κ轻链型MM患者的临床资料和实验室结果 .结果3例患者中,男性2例,女性1例,年龄50~82岁,主要表现为腰痛、感染、贫血和肾功能损害,X线和(或)磁共振成像检查均显示多发溶骨性骨质破坏.血清IgG正常、轻度或明显升高,IgA和IgM均降低.血清和尿液κ轻链均明显升高,尿本周蛋白均阳性.2例患者血清蛋白电泳可见γ区形成双M蛋白峰.血清免疫固定电泳可见抗IgG单条带和抗κ轻链双条带.骨髓涂片可见异常浆细胞明显增多.2例患者分别接受DVD、VAD方案化疗达部分缓解和疾病稳定,1例患者因肺部感染、急性左心衰竭、急性肾衰竭放弃治疗.结论 IgG-2κ轻链型MM临床表现缺乏特征性,但某些实验室特点可能不同于IgG-κ轻链型,是否属于双克隆型MM有待研究证实.     

毛细管电泳技术在多发性骨髓瘤诊断及MRD监测中的价值

目的:探讨毛细管电泳免疫分型技术在多发性骨髓瘤初诊及微小残留病变(MRD)监测中的意义.方法:采用毛细管电泳免疫分型技术对临床疑似由单克隆免疫球蛋白增多引起的肾病、血液病等初诊患者671例进行血清检测.连续追踪32例初诊诊断为多发性骨髓瘤的患者,毛细管分型电泳监测MRD,并与流式细胞仪监测结果进行对比.结果:单克隆免疫球蛋白增多者265例,阳性率39.5％,其中IgG-K型91例(34.3％),IgG-λ型57例(21.5％),lgA-K型25例(9.4％),IgA-λ型20例(7.5％),IgM-K型16例(6.0％),IgM-λ型5例(1.9％),游离K轻链型12例(4.5％),游离λ轻链型26例(9.8％),双克隆型11例(4.2％),其它型2例(0.8％).连续监测32例多发性骨髓瘤患者MRD,患者诱导化疗缓解后3个月毛细管电泳MRD监测阳性率为46.9％,流式细胞仪阳性率为75.0％,两种方法比较,差异有显著性(P＜0.05);诱导化疗缓解后6个月毛细管电泳MRD监测阳性率为28.1％,流式细胞仪阳性率为43.8％,两种方法比较无显著性差异.结论:毛细管电泳免疫分型技术对多发性骨髓瘤的诊断具有较高的敏感性及特异性,MRD监测虽不及流式细胞仪灵敏,但与流式细胞仪同时监测可减少漏检率.     

多发性骨髓瘤合并肾功能不全患者的临床特点

目的 探讨多发性骨髓瘤合并肾功能不全患者的临床特点.方法 随机抽取102例MM患者的临床资料,按照患者出现肾功能不全的时间不同分为A组、B组、C组.A组34例,B组12例,C组56例.A组患者在初诊时发现合并肾功能不全;B组患者为初诊时无肾功能不全者,在疾病进展过程中出现肾功能不全;C组为疾病治疗过程中未出现肾功能不全的患者.观察患者临床表现、免疫分型及临床疗效.结果 A组和B组患者Scr、血清钙、UA、β2-MG、浆细胞水平显著高于C组,差异有统计学意义(P＜0.05).A组LDH水平显著低于B组,差异有统计学意义(P＜0.05).46例合并肾功能不全的患者中,IgAλ轻链型的比例显著高于IgAk轻链型,差异有统计学意义(P＜0.05).C组中位生存期显著高于A组和B组,差异有统计学意义(P＜0.05).结论 多发性骨髓瘤合并肾功能不全患者临床表现为高水平的Scr、血清钙、UA、β2-MG、浆细胞,而且IgAλ轻链型的比例较高.     

IgE骨髓瘤1例报告及文献复习(英文)

目的报告1例 IgE 骨髓瘤病例并将其临床特征与义献进行比较。方法对1例骨髓瘤患者的血清尿液采用醋酸纤维膜电泳、免疫固定电泳和免疫球蛋白定量等方法鉴定 M 蛋白,采用直接和间接免疫酶标技术检测瘤组织 IgE 及轻链的表达。结果醋酸纤维膜电泳显示住快γ区有一单克隆小峰,占18%.免疫固定电泳结果显示一单克隆区带,与λ抗血清反应,与κ、IgG、IgA、IgM、IgD 抗血清不反应。免疫球蛋白定量结果显示 IgG 21.6 g/L,IgA 1.2 g/L,IgM 2.64 g/L,κ 7.49 g/L,λ16.0 g/L,κ/λ0.47。免疫组织化学染色结果表明瘤组织 IgE 及λ轻链,不表达κ轻链。结论本文所报告的病例为国内首例 IgE 多发性骨髓瘤。     

钙蛋白酶小亚基1与核因子κB在乳腺癌中的表达及与患者临床特征的关系

目的 探讨钙蛋白酶小亚基1(CAPN4)与核因子κB(NF-κB)在乳腺癌中的表达及与患者临床特征的关系.方法 取98例乳腺癌患者的乳腺癌组织和相应的癌旁组织,免疫组化法检测CAPN4、NF-κB蛋白的表达情况,分析其与乳腺癌患者临床特征的关系.采用Spearman法分析CAPN4和NF-κB蛋白表达的相关性.随访1年,比较不同CAPN4、NF-κB蛋白表达情况乳腺癌患者同侧乳腺癌复发率和术后肿瘤细胞转移率.结果 乳腺癌组织中CAPN4、NF-κB蛋白的高表达率均明显高于癌旁组织(P﹤0.01).TNM分期为Ⅲ～Ⅳ期、中低分化程度、雌激素受体表达阳性、有淋巴结转移乳腺癌患者乳腺癌组织中CAPN4、NF-κB蛋白高表达率均高于TNM分期为Ⅰ～Ⅱ期、高分化程度、雌激素受体表达阴性、无淋巴结转移的乳腺癌患者,差异均有统计学意义(P﹤0.05).Spearman相关分析结果显示,CAPN4蛋白的表达与NF-κB蛋白的表达呈正相关(P﹤0.05).术后随访1年,CAPN4高表达患者同侧乳腺癌复发率为17.31%,高于CAPN4低表达患者的4.35%(P﹤0.05),术后肿瘤细胞转移率为19.23%,高于CAPN4低表达患者的4.35%(P﹤0.05);NF-κB高表达患者同侧乳腺癌复发率为18.18%,高于NF-κB低表达患者的2.33%(P﹤0.05),术后肿瘤细胞转移率为18.18%,高于NF-κB低表达患者的4.65% (P﹤0.05).结论 CAPN4和NF-κB蛋白在乳腺癌患者乳腺癌组织中均呈高表达,与TNM分期、分化程度、雌激素受体表达情况和淋巴结转移情况密切相关,二者可能协同促进了乳腺癌的发生发展.     

IgE骨髓瘤1例报告及文献复习

目的 报告1例IgE骨髓瘤病例并将其临床特征与文献进行比较。方法 对1例骨髓瘤患者的血清尿液采用醋酸纤维膜电泳、免疫固定电泳和免疫球蛋白定量等方法鉴定M蛋白,采用直接和间接免疫酶标技术检测瘤组织IgE及轻链的表达。结果 醋酸纤维膜电泳显示在快γ区有一单克隆小峰,占18％。免疫固定电泳结果显示一单克隆区带,与λ抗血清反应,与κ、IgG、IgA、IgM、IgD)抗血清不反应。免疫球蛋白定量结果显示IgG 21.6g/L,IgA 1.2g/L,IgM 2.64g/L,κ 7.49 g/L,λ16.0g/L,κ/λ0.47。免疫组织化学染色结果表明瘤组织IgE及λ轻链,不表达κ轻链。结论 本文所报告的病例为国内首例IgE多发性骨髓瘤。     

血清单克隆免疫球蛋白在慢性B淋巴细胞增殖性疾病中的表达及其意义

目的 研究血清单克隆免疫球蛋白(McIg)在慢性B淋巴细胞增殖性疾病(B-CLPD)中的表达情况,分析其临床意义及可能来源.方法 回顾性分析2006年5月至2015年5月1 147例初诊B-CLPD患者临床资料,分析血清McIg表达情况及预后相关因素,探讨其来源.结果 1 147例B-CLPD患者中淋巴浆细胞淋巴瘤/华氏巨球蛋白血症(LPL/WM)患者164例,其中140例(85.4％)存在McIg;非LPL/WM患者983例,其中50例(5.1％)存在McIg;两组McIg类型均以IgM型为主.McIg阳性LPL/WM组、McIg阳性的非LPL/WM组及McIg阴性组患者血清IgM浓度分别为(48.88±33.42)g/L、(27.9±15.23)g/L、(2.75±1.21)g/L,差异有统计学意义(P=0.000),McIg阳性的LPL/WM组IgM浓度高于McIg阳性非LPL/WM组(P=0.000),且两组患者血清IgM浓度均高于McIg阴性者(P值均为0.000).分析16例McIg阳性非LPL/WM的B-CLPD患者显示,治疗后完全缓解期间单克隆IgG、Igi的水平变化均低于初诊时(P值分别为0.001、0.048).非LPL/WM的B-CLPD患者中β 2微球蛋白高水平组及染色体复杂核型组血清McIg阳性率分别高于B2微球蛋白低水平组(P=0.001)及染色体正常核型组(P=0.016).47例McIg阳性的非LPL/WM患者中,38例(80.9％)血清McIg表达类型与肿瘤细胞表面Ig轻链的类型一致,二者中度相关(P＜ 0.005).结论 部分非LPL/WM的B-CLPD患者血清中也存在McIg,且可能和预后有一定相关性.McIg可能是由肿瘤细胞或与肿瘤细胞有共同前体的细胞分泌的.     

MASS-FIX for the detection of monoclonal proteins and light chain N-glycosylation in routine clinical practice: a cross-sectional study of 6315 patients

Immunoenrichment-based matrix assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS), termed MASS-FIX, offers several advantages over immunofixation for the detection and isotyping of serum monoclonal protein, including superior sensitivity and specificity, the ability to differentiate therapeutic monoclonal antibodies, and the rapid identification of light chain (LC) N-glycosylation. We identified 6315 patients with MASS-FIX performed at our institution since 2018. Of these, 4118 patients (65%) with a wide array of plasma cell disorders (PCD), including rare monoclonal gammopathies of clinical significance, had a positive MASS-FIX. Two-hundred twenty-one (5%) of the MASS-FIX positive patients had evidence of LC N-glycosylation, which was more commonly identified in IgM heavy chain isotype, kappa LC isotype, and in diagnoses of immunoglobulin light chain (AL) amyloidosis and cold agglutinin disease (CAD) compared to other PCD. This cross-sectional study describes the largest cohort of patients to undergo MASS-FIX in routine clinical practice. Our findings demonstrate the widespread utility of this assay, and confirm that LC N-glycosylation should prompt suspicion for AL amyloidosis and CAD in the appropriate clinical context.Subject terms: Myeloma, Translational research     

Discordant response or progression in patients with myeloma treated with thalidomide-based regimens

Thalidomide-based regimens (TBR) are now widely used for the treatment of refractory multiple myeloma and have shown significant activity in newly diagnosed patients. In some patients with secretory disease, we observed discrepancies between the reduction of the monoclonal protein levels and the plasma cell infiltration in the bone marrow and/or extramedullary sites of relapse after treatment with TBR. The purpose of this study was to assess the incidence and analysis of this phenomenon in all myeloma patients treated with TBR in our Institution. PATIENTS AND METHODS: We studied all patients who received TBRs and had a follow up time of at least 6 months. Partial response (PR) was defined as at least 50% reduction of serum myeloma protein and soft tissue plasmacytomas and/or > 90% reduction of Bence Jones protein excretion and minor response as a > 25% reduction of the serum myeloma protein or > 50% reduction of the Bence Jones myeloma protein. RESULTS: Between July 1999 and July 2002 we treated 94 patients with advanced myeloma and 9 patients with newly diagnosed disease with TBR. Sixty-seven patients (66%) achieved either partial or minor response. In 4 patients (3 with advanced and 1 with newly diagnosed myeloma) the bone marrow was heavily infiltrated by plasma cells, despite a decrease of the paraprotein levels ranging from 38% to 68%. This discordance between monoclonal protein levels and bone marrow plasmacytosis was noted in 6% of patients rated as responders and in 11% of responding patients who actually had a repeat bone marrow assessment. Furthermore 6 responding patients, after achieving a PR which lasted between 5 and 9 months, relapsed with bone marrow (all cases), and extramedullary (2 cases) plasmacytosis, without increase of serum and/or urine monoclonal protein. This hyposecretory conversion was noted in 12.5% of relapsing patients. CONCLUSION: Our data indicate that after treatment with TBR some patients with myeloma show discordant responses of the monoclonal protein levels and the bone marrow or extramedullary plasmacytosis. If our data are confirmed, they may have practical implications for assessment of response and follow up of patients treated with TBR.     

Serum free light chains in myeloma patients with an intact M protein by immunofixation: potential roles for response assessment and prognosis during induction therapy with novel agents

The ascertainment of serum free light chain (sFLC) levels has been shown to be valuable in screening for the presence of plasma cell dyscrasia as well as for baseline prognosis in newly diagnosed patients. For patients with amyloidosis and those with oligo-secretory or non-secretory multiple myeloma (MM), serial measurement of sFLC has also been shown to be valuable in monitoring disease status. However, in patients with a measureable, intact monoclonal protein by immunofixation (M protein), the serial measurement of sFLC remains undefined and is currently not recommended in professional guidelines. Herein, we provide data comparing sFLC with M protein as biomarkers of response in newly diagnosed patients with MM undergoing induction therapy with the novel agents thalidomide, lenalidomide and/or bortezomib. We show that although M protein appears to outperform sFLC comparatively over the course of induction therapy, the addition of FLC to M protein further informs the characterization of residual disease status post-induction. Moreover, sFLC at the time of stem cell mobilization appears to hold prognostic power for survival endpoints following high-dose chemotherapy/autologous stem cell transplant (HDC/SCT). These findings suggest potentially novel roles for sFLC in patients with MM with an intact M protein receiving novel agent-based induction strategies followed by HDC/SCT.     

A descriptive study of plasma cell dyscrasias in Egyptian population

BackgroundPlasma cell dyscrasias (PCDs) refer to a spectrum of disorders characterized by the monoclonal proliferation of lymphoplasmacytic cells in the bone marrow and, sometimes, tissue deposition of monoclonal immunoglobulins or their components. These disorders include multiple myeloma (MM) and Waldenström’s macroglobulinemia, as well as rare conditions such as light-chain deposition disease (LCDD) and heavy-chain diseases (HCDs). The worldwide annual incidence of MM is estimated at 86,000, which is approximately 0.8% of all new cancer cases.PurposeOur retrospective study aims to highlight the immunologic and epidemiological features of PCDs mainly MM in Egyptian patients and compare our results with those of other populations.MethodsTwo hundred seventeen Egyptian patients with PCD were enrolled in the study. Serum, urine protein electrophoresis and immunofixation were used to demonstrate M protein.ResultsOne hundred thirty-eight patients (63.6%) had IgG monoclonal band, 38 patients (17.5%) had IgA, 12 patients (5.5%) had Waldenström’s macroglobulinemia (IgM monoclonal band) and 29 patients (13.4%) were light chain myeloma. One hundred fifty-one (70%) were Kappa chain positive and 66 patients (30%) were lumbda positive. Conventional cytogenetics was available for 40 patients; of them12 patients (30%) showed 13q-. Mean OS was 37.5 months (1–84 months). Survival analysis was statistically insignificant according to age, sex and ISS or type of treatment (P value > 0.05).ConclusionLong term follow up is required to further define the role of different therapeutic lines of treatment including ASCT in the various stages of PCD based on OS data.     

Monoclonal Gammopathies After Renal Transplantation: A Single-center Study

IntroductionPlasma cell disorders (PCDs) are clonal plasma cell disorders that include conditions such as monoclonal gammopathy of undetermined significance (MGUS), monoclonal gammopathy of renal significance (MGRS), multiple myeloma (MM), smoldering MM (SMM), solitary plasmacytoma, and light-chain (AL) amyloidosis. The risk factors associated with and the clinical course of PCDs after renal transplantation is not well established although immunosuppressive protocols may impact the incidence and natural history of PCDs posttransplant.Patients and MethodsThis single-center retrospective study evaluated patients with a history of renal transplant who developed a PCD between January 1, 2014-December 31, 2018.ResultA total of 41 patients met the inclusion criteria including 29 with MGUS and 12 with symptomatic PCD (4 with MM, 2 with SMM, 4 with MGRS, 1 with AL amyloidosis, and 1 with solitary plasmacytoma). The median follow-up of survivors was 41.6 months. Three patients (1 with MGUS and 2 with MGRS) progressed to MM during the follow-up period. There was a male preponderance in both groups. There was no correlation between the donor and immunosuppressive regimen and the development of a PCD. Patients with symptomatic PCD had higher serum creatinine and M-protein levels at diagnosis and higher free light chain ratio and plasma cell burden. There was also a higher percentage of allograft failure noted in the symptomatic PCD subset 50% (n = 6), whereas only 23% (n = 7) of patients had allograft failure in the MGUS group.ConclusionThis study shows the importance of considering monoclonal gammopathy in the differential of renal dysfunction after kidney transplant and the need to follow these patients closely to monitor for progression to symptomatic PCD.     

血清游离轻链在多发性骨髓瘤诊断及疗效监测中的临床意义

 目的　探讨血清游离轻链（sFLC）在多发性骨髓瘤（MM）诊断和疗效监测中的临床意义。方法　采用免疫比浊法检测62例MM患者在疾病不同阶段sFLC κ与λ浓度,计算其比值。以35例慢性肾功能不全（CRF）患者及62名健康供血者为对照。结果　健康对照组sFLC中κ值（13.25±6.46）mg／L,λ 值（18.39±11.42）mg／L;κ／λ比值0.97±0.64（范围0.33～1.61）。CRF患者sFLC值为（200.01±299.87）mg／L,λ值为（191.02±245.98）mg／L,显著高于健康对照组（t＝-17.804、-16.894,均P＜0.001）;但κ／λ比值（1.11±0.29）在正常范围内。57例分泌型MM,新诊断IgGκ、IgAκ、IgDκ型MM患者的κ值范围16.20～35 250 mg／L,IgGλ、IgAλ、IgDλ型MM患者的λ值范围为15.70～4885 mg／L。96.5 %（55／57）患者存在κ／λ比值异常（＜0.5或＞1.5）。治疗后达缓解／平稳期κ、λ水平及κ／λ比值趋于正常。结论　sFLC检测对于MM患者的诊断、治疗效果及疾病复发的监测较常规检测方法更为敏感。     

Incidence of second neoplasms in patients with MALT lymphoma: No increase in risk above the background population

Background: Lymphomas of mucosa associated lymphoid tissue (MALT) are a special type of extranodal lymphoma, possibly related to chronic antigenic stimulation. Increased cancer susceptibility may also contribute to the development of MALT lymphoma (MALToma). It has been suggested that patients with MALToma have an increased incidence of other malignancies.Patients and methods: We retrospectively reviewed the histology and clinical records of 147 patients with MALToma, including 51 cases of gastric MALToma. The incidence of any second malignancy was confirmed with a provincial registry. The relative rates of cancer, excluding MALToma, were calculated relative to the background population of the same age group and secular year.Results: A total of 41 tumors occurred in 32 patients (21%), including 22 solid tumors. The incidence of solid tumors in the gastric MALToma group was 15%. Seven patients had two or more second malignancies. Cancer occurred before diagnosis of MALToma in 29 cases, concurrent with MALToma in three, and after MALToma in nine. Follow-up of the surviving patients is short (median 17.6 months). The relative rate from birth of a second malignancy was 0.86 in the whole group (90% confidence interval (CI): 0.62–1.16) and 0.95 (90% CI: 0.55–1.54) in the gastric MALToma group. The rates were roughly the same if skin cancers were excluded.Conclusions: The incidence of second cancers in this series is similar to previous reports. However, when compared to an age-matched population followed for the same period of time, MALToma patients do not appear to have a statistically significant increased rate of cancers.     

改良TCD方案治疗初治多发性骨髓瘤26例临床观察

目的观察改良TCD方案(小剂量沙利度胺和地塞米松联合环磷酰胺）治疗初治多发性骨髓瘤的临床疗效。方法应用改良TCD方案6周期治疗26例初治多发性骨髓瘤患者,应用血清蛋白电泳、免疫固定电泳、骨髓细胞形态学和β2-微球蛋白评估治疗效果,同时观察药物的不良反应。结果CR 6例,nCR 7例,PR 5例,轻度反应2 例;总有效率69.2%,总反应率76.9%。化疗不良反应轻,无治疗相关性死亡。结论 改良TCD方案治疗初治多发性骨髓瘤疗效较好,不良反应较少,值得临床推广应用。