《中国肿瘤临床》文章推荐:修订的国际分期系统对初诊多发性骨髓瘤患者预后评估价值及局限性

多发性骨髓瘤(multiple myeloma,MM)是骨髓中浆细胞恶性增殖同时伴有靶器官损害的一类血液系统恶性肿瘤。近年来,随着靶向新药以及造血干细胞移植的广泛应用,MM患者的预后得到了较大的改善。MM又是一类异质性很强的肿瘤,患者生存期从数月至数十年不等。因此,建立一种在初诊时能将患者的预后进行大致区分并提供一定的临床治疗指导的预后评估系统,是一项较有意义的临床课题。     

多发性骨髓瘤免疫标志联合国际分期系统分期对临床治疗及预后判断的意义

 【摘要】　目的　探讨多发性骨髓瘤（MM）瘤细胞的免疫标志特征、CD28及国际分期系统（ISS）分期在临床治疗及预后判断的意义。方法　用四色流式细胞仪检测49例初诊及22例治疗组MM患者瘤细胞膜表面免疫标志的表达情况,并将患者依据ISS分期法、综合风险组分期,对疗效、生存期进行评价分析。结果　随着ISS分期升高,治疗有效率降低[Ⅰ、Ⅱ、Ⅲ期有效率分别为83.3 %（4／6）、38.5 %（5／13）、36.5 %（19／52）]（χ2＝4.235,P＝0.04）,总生存期及无进展生存期缩短,组间比较差异有统计学意义（均P＜0.05）。CD28的异常表达率在初诊及治疗组患者之间差异无统计学意义[27（55.1 %）、14（63.4 %）]（P＞0.05）,CD+28组患者较CD-28 组的生存期缩短,差异有统计学意义（P＝0.040）。综合风险组中,高危组较低危组治疗有效率降低,差异有统计学意义（χ2＝5.620,P＝0.018）,总生存期及无进展生存期缩短,差异有统计学意义（P＜0.01）。结论　MM患者高ISS分期、CD+28表达者、高危组预后较差。     

MRP评分联合IPSI评分对初诊多发性骨髓瘤患者预后的评估价值

目的:探讨真实世界中英国骨髓瘤联盟危险分层评分(UK myeloma research alliance risk profile, MRP)预后评分系统与炎症指数评分(inflammatory prognostic scoring index, IPSI)预后评分系统对基于硼替佐米治疗的初诊多发性骨髓瘤患者的预后评估价值。方法:回顾性分析本院血液科2007年01月01日至2018年06月30日初发的多发性骨髓瘤患者临床及实验室资料,使用两种预后评分系统对患者预后进行评估比较。结果:MRP预后评分系统与IPSI预后评分系统对初诊多发性骨髓瘤患者均可进行危险度分层。且同时符合MRP及IPSI定义的低危或高危组患者的OS和PFS较其他组具有统计学差异。结论:同时具有MRP高危因素及IPSI高危因素的骨髓瘤患者属超高危患者,预后极差,两种简易预后模型的综合应用可以作为现有主流预后模型的补充。     

206例多发性骨髓瘤预后因素分析及分期评价

背景与目的:多发性骨髓瘤(multiplemyeloma,MM)是一种异质性的浆细胞肿瘤,预后不良。本研究旨在探讨我国MM患者的预后因素和适用的临床分期。方法:对206例MM患者的18项临床和实验室指标进行单因素和多因素分析,并将患者分别按4种分期法进行分期,比较各期患者的生存情况。结果:206例患者中男性138例,女性68例,中位年龄59岁(27～90岁),中位生存期为33个月,2年生存率为64.7%,5年生存率为33.7%。单因素分析发现,年龄、骨髓浆细胞总数、血红蛋白、血小板计数、校正钙浓度、白蛋白、肌酐、β2微球蛋白、C反应蛋白、骨病分级与预后相关。多因素分析显示C反应蛋白、β2微球蛋白、白蛋白、年龄为独立的预后因素。DurieSalmon(DS)分期、Bataille分期中三期间和国际分期系统(ISS)中Ⅰ期、Ⅱ期患者的生存期有显著性差异;英国医学研究理事会(BMRC)分期中三期间和ISS分期中Ⅱ期、Ⅲ期患者的生存期无显著性差异。结论:高C反应蛋白、高β2微球蛋白、低白蛋白、高龄的患者预后较差,DS分期和Bataille分期对我国患者比较适合。     

多发性骨髓瘤的预后评估与危险分层治疗

 新的靶向治疗药物（沙利度胺、硼替佐米、雷利度胺、砷剂）治疗MM取得了突破性进展,明显改善了MM的预后。MM的临床异质性是由生物学特性所决定的,正确地评估患者的预后,对不同患者进行分层治疗极为重要。     

多发性骨髓瘤的诊断进展与分期

多发性骨髓瘤(multiple myeloma,MM)是一种浆细胞恶性肿瘤,随着研究的深入,对MM的诊断不再局限于骨髓活检与影像学检查,而是向血清游离轻链、细胞遗传学和分子生物学检测方向发展,这使医务人员对该疾病的发生机制有了更深的了解,同时为预后评估提供了重要依据。下面主要从MM的实验室检查、诊断标准和分期3个方面对近年MM的诊断及其进展进行综述。     

多发性骨髓瘤的预后评估与危险分层治疗

新的靶向治疗药物(沙利度胺、硼替佐米、雷利度胺、砷剂)治疗MM取得了突破性进展,明显改善了MM的预后.MM的临床异质性是由生物学特性所决定的,正确地评估患者的预后,对不同患者进行分层治疗极为重要.     

WHO多发性骨髓瘤的诊断与分期

介绍WHO关于多发性骨髓瘤的诊断与临床分期标准,并对多发性骨髓瘤与反应性浆细胞增多的鉴别进行讨论。     

肾功能对多发性骨髓瘤患者疲劳状态及预后的影响

目的 探讨肾功能对多发性骨髓瘤(MM)患者疲劳状态及预后的影响.方法 根据是否发生肾功能损伤将42例MM患者分为无肾功能损伤组(n=23)和肾功能损伤组(n=19).在采取同样治疗方法的情况下,比较两组患者的实验室指标(血钙、血红蛋白及乳酸脱氢酶)、疲劳状态[多维疲劳量表(MFI)]及生存情况.结果 无肾功能损伤组患者...     

Prognostic factors and staging in multiple myeloma

The field of multiple myeloma prognostication is replete with studies that have shown the value of independent predictors in determining clinical outcome. It is clear that host factors and factors intrinsic to the cells are the ultimate determinants of prognosis. In the immediate period after diagnosis, those factors related to the host are likely to be more relevant, whereas with passing time factors intrinsic to the cells predominate. At a minimum, we recommend that a comprehensive molecular cytogenetic assessment be performed at diagnosis, together with conventional evaluation, including beta2-microglobulin and albumin. In addition, information on proliferative activity of plasma cells may be of value. The introduction of novel methods of prognostication should be strongly considered in all clinical trials.     

新诊断老年多发性骨髓瘤的预后分层及治疗进展

多发性骨髓瘤是一种好发于中老年人的浆细胞恶性增殖性疾病,目前仍不可治愈,中位诊断年龄为69岁,50％以上的患者在诊断时年龄大于75岁.近年来新药的应用显著改善了多发性骨髓瘤患者的总生存期和无进展生存期,但标准方案并不能让老年多发性骨髓瘤患者受益,可能还会降低患者生活质量,增加死亡率.因此,精准的预后评估及危险度分层对于...     

Treatment of newly diagnosed multiple myeloma

Multiple myeloma (MM) is the second most common oncohematologic disease. Most patients are older than 65 years at diagnosis, and different therapeutic options are available depending on the age of the patient. For those younger than 65 years, autologous stem cell transplantation is the standard of care, whereas in older patients the better choice is conventional chemotherapy. The introduction of thalidomide, bortezomib, and lenalidomide, which target MM cells and the bone marrow microenvironment, has changed the therapeutic options in newly diagnosed patients with MM.     

新诊断的多发性骨髓瘤的治疗选择

根据国际骨髓瘤工作组（IMWG）关于骨髓瘤的最新分类可以将多发性骨髓瘤（MM）大致分为两类：无症状骨髓瘤（冒烟型骨髓瘤）和有症状的MM。前者相当于Durie-Salmon（DS）I期,此类患者不需要治疗,只需定期复查和观察;后者相当于DSⅡ、Ⅲ期,需要立即进行治疗。2007年美国国家综合癌症网络协会（NCCN）建议Ⅱ期或Ⅲ期、机体状态良好的MM患者行自体干细胞移植（ASCT）。因此应根据是否适合行ASCT对新诊断MM患者选择不同的诱导治疗方案。     

Evolving paradigms in the treatment of newly diagnosed multiple myeloma

The treatment of multiple myeloma has undergone significant changes in the past few years. The introduction of novel agents, such as the immunomodulatory drugs thalidomide and lenalidomide and the proteasome inhibitor bortezomib, has dramatically improved the outcome of this disease and considerably increased the treatment options available. Several trials have shown the advantages linked to the use of novel agents both in young patients, who are considered eligible for transplantation, and elderly patients, for whom a conventional therapy should be considered. These novel agents may increase the efficacy of autologous stem cell transplantation with deeper and long-lasting response. In the transplant setting, different novel agent combinations have proved to be superior to the traditional vincristine-doxorubicin-dexamethasone. Similarly, novel agents have also changed the treatment paradigm of patients not eligible for transplantation, thus replacing the traditional melphalan-prednisone approach. Preliminary data also support the role of consolidation and maintenance therapy to further improve outcomes. This article provides an overview of the latest strategies, including novel agents used to treat patients with multiple myeloma, both in the transplant and nontransplant settings.     

初发多发性骨髓瘤的治疗进展

多发性骨髓瘤（MM）是一种恶性浆细胞肿瘤。MM患者大多数年龄超过65岁,目前认为65岁以下初发MM患者的标准治疗为大剂量美法仑化疗支持的自体干细胞移植（ASCT）,而65岁以上老年MM患者的标准治疗至今仍认为是口服美法仑和泼尼松（MP）方案。但是一些新药的发明,如沙利度胺、雷利度胺和蛋白酶体抑制剂硼替佐米,能针对骨髓瘤细胞和骨髓微环境进行靶向治疗,联合使用在很大程度上能提高以往化疗方案的临床疗效。     

Prognostic factors and staging in multiple myeloma: a reappraisal

To assess the important factors in the prognosis and staging of multiple myeloma (MM), we have correlated the presenting clinical features of 147 previously untreated patients with MM with the survival duration using multiple regression analyses. We have included the three major available myeloma-staging systems (MSS), ie, Durie-Salmon (DS), Medical Research Council (MRC), and Merlini-Waldenstr?m-Jayakar (MWJ), plus two new variables related to disease activity: the serum beta 2-microglobulin level (S beta 2M) and the instantaneous rate of bone resorption. Our study confirms the validity of the three MSS in the prediction of survival duration, with a slight but significant advantage for the DS MSS. Among single variables, S beta 2M was the most powerful indicator of prognosis (P less than .0001), serum albumin level being the only variable adding to this significantly (P = .02). Of major interest, S beta 2M alone was a better indicator than MRC and MWJMSS. Finally, S beta 2M and the serum albumin level, variables not included in the three MSS, were better indicators than the classical DS MSS and could be combined simply to give a very powerful system of stratification.     

65岁以上老年多发性骨髓瘤初治的化疗进展

多发性骨髓瘤（multiple myeloma,MM）是以骨髓单克隆浆细胞增多为特征的B细胞恶性肿瘤。对于老年（65岁以上）多发性骨髓瘤初治一般采用马法兰加泼尼松（MP）方案治疗,但其总的缓解率及生存率低。近几年来一些新的化疗药物对多发性骨髓瘤初治的疗效得到了肯定。本文就老年多发性骨髓瘤初治的化疗新进展作一综述。