多发性骨髓瘤误诊原因探讨（附34例分析）

目的 探讨多发性骨髓瘤误诊原因，提高对其临床表现的认识，减少误诊。方法 回顾性分析34例多发性骨髓瘤误诊经过。结果 18例误诊为腰肌劳损、老年人退行性骨质增生、风湿性关节炎，5例误诊为冠心病，3例上呼吸道感染、肺炎，4例误诊为慢性肾炎、肾功能不全，3例误诊为缺铁性贫血，1例误诊为原发性甲状腺功能亢进症。结论 由于浆细胞侵犯骨髓部位不同，致使其临床表现多种多样。故凡具有药物不能抑制的骨关节疼痛，不明原因的中老年人贫血、血沉加快、蛋白尿、高钙血症、反复发生的感染等均应作必要实验室检查、X线检查及SPECT全身骨扫描，以免误诊。     

多发性骨髓瘤30例误诊原因分析

文章主要分析多发性骨髓瘤的误诊原因及解决方法.临床表现多样性导致误诊,系统分析及全面检查是减少误诊的重要措施.对可疑病人进行全面系统的检查,尤其X线检查、血尿蛋白电泳、免疫球蛋白测定及多部位骨髓穿刺是确诊该病的重要手段.     

多发性骨髓瘤误诊1例报告

1病例报告 患者男性,57岁。因咳嗽20余天,右胸背部疼痛1周入院。患者20余天前受凉后出现咳嗽,咳少量黄色黏稠痰,不易咳出,无发热、咯血,在其单位职工医院拍摄胸部正位X线片,提示＂右肺中叶炎症＂,给予＂洛美沙星＂等静脉滴注抗感染治疗5天,症状好转后即自行停止治疗。     

多发性骨髓瘤误诊3例临床分析

目的：研究多发性骨髓瘤（MM）的临床特征,误诊原因。方法：对我院误诊的3例多发性骨髓瘤病例进行回顾性分析。结果：MM首发症状与临床表现复杂多变,极易误诊、漏诊。结论：对MM的临床表现要综合分析,外周血涂片形态学检查可为临床提供重要参考,骨髓细胞学检查及骨髓活组织检查是确诊的首要方法。完善MM相关检测对避免误诊有重要意义。     

35例多发性骨髓瘤误诊分析

目的 探讨多发性骨髓瘤(MM)的误诊原因。方法 对35例MM误诊病例进行回顾分析。结果 MM可表现为骨痛和自发性骨折、贫血、反复发生的感染、蛋白尿及肾衰竭等。结论 MM起病隐匿,提高对MM临床表现的认识将有利于诊断率的提高。     

多发性骨髓瘤误诊分析

我院近年来收治MM病人27例，其中17例先后在院内外首诊时被误诊为18种疾病，误诊率为63％，误诊时间为2个月至3年，发病年龄在46—75岁之间，平均年龄61岁，其中男性9例，女性8例。本文通过对17例误诊病例的分析，证实了MM的临床表现呈多样化、复杂化。如果临床对本病警惕性不高，极易被误诊。同时强调，争取早期诊断、早期治疗，是改善预后、延长生存期的关键。     

20例存活7年以上多发性骨髓瘤患者临床观察

[目的]分析生存期大于7年的多发性骨髓瘤患者的临床特点。[方法]回顾性分析了20例存活7年以上的多发性骨髓瘤患者的一般情况、临床特征、治疗与预后。[结果]7年存活率11.1%（20/180）,10例（50.0%）患者在疾病进展期出现髓外瘤细胞的浸润。20例患者共接受了中位数28（15-41）个周期的化疗,复发患者接受了以硼替佐米为主的化疗方案、DECP方案、来那度胺、三氧化二砷及脂质体阿霉素治疗。20例患者的中位生存期为91（84-120）个月,至随访结束,仍有11例患者存活。[结论]多发性骨髓瘤的预后除与肿瘤负荷、宿主因素、肿瘤生物学等有关外,还与治疗措施及治疗反应密切相关。     

Pooled Analysis of Pomalidomide for Treating Patients with Multiple Myeloma

Background: Patients with refractory or relapsed multiple myeloma are considered to have a very poorprognosis, and new regimens are needed to improve this setting. Pomalidomide is a new immunomodulatorydrug with high in vitro potency. Immunomodulatory drugs are hypothesized to act through multiple mechanisms.Here we performed a systemic analysis to evaluate pomalidomide-based chemotherapy (pomalidomide incombination with low-dose dexamethasone) as salvage treatment for patients with refractory and relapsed multiplemyeloma. Methods: Clinical studies evaluating the efffectiveness of pomalidomide based regimens on responseand safety for patients with refractory and relapsed multiple myeloma were identified using a predefined searchstrategy. Pooled response rate (RR) of treatment were calculated. Results: For pomalidomide based regimens,4 clinical studies which including 291 patients with refractory and relapsed multiple myeloma were consideredeligible for inclusion. Systemic analysis suggested that, in all patients, pooled RR was 41.2% (120/291). Majoradverse effects were hematologic toxicity, including grade 1 or 2 anemia, leucopenia and thrombocytopeniawith pomalidomide based treatment. No treatment related death occurred. Conclusion: This pooled analysissuggests that pomalidomide in combination with low-dose dexamethasone is active with good tolerability intreating patients with refractory or relapsed multiple myeloma.     

The Clonogenic Precursor Cell in Multiple Myeloma

Multiple myeloma is characterized by the monoclonal expansion of plasma cells in the bone marrow. Although the predominant cell type is the plasma cell, the initial oncogenic transformation is considered to take place in a more immature B cell. There is still much controversy about this precursor cell type. Phenotypic analysis of bone marrow and peripheral blood revealed that in multiple myeloma a great diversity exists in the phenotype of the cells considered to be involved. Because of the lack of a myeloma specific genetic lesion it is very difficult to trace back the cell in which the transforming event, leading to multiple myeloma, took place. The only real clonal marker is the idiotype of the immunoglobulin molecule expressed by the myeloma cells. With recombinant DNA technology it is now possible to produce clonal markers for each individual myeloma patient which recognize only the immunoglobulin genes expressed by the myeloma cell and its precursors. The sequences of these myeloma immunoglobulin genes do reveal a lot of information about the stage in the B-cell differentiation pathway in which the oncogenic event might have taken place.

The presence of somatic mutations in a non-random fashion without intraclonal variation leads to the conclusion that the precursor myeloma cell could not possibly be a pre-B cell or stem cell but has to be a mature B cell that has been in contact with antigen and has past through the phase of somatic mutation, like a memory B cell or plasmablast. The identification of a small population of clonally related pre-switched B cells in the peripheral blood, harbouring exactly the same somatic mutations as the myeloma immunoglobulin sequence, is not contradictory with this model although the self-renewal capacity of this population is not yet clear.     

鼻咽癌误诊42例分析

目的　探讨鼻咽癌 (Nasopharyngealcarcinoma ,NPC)的误诊原因及对策。方法　对 42例误诊的NPC病人的临床资料作回顾性分析。结果　误诊率 15 .1%。误诊为慢性淋巴结炎 33例、中耳炎 3例、偏头痛 2例、颈淋巴结结核 2例、慢性鼻炎 2例。县乡级医院误诊占 6 9%,市级及以上医院误诊占 31%;非专科误诊占 73.8%,专科误诊占 2 6 .2 %。误诊后行颈部肿块手术的占 2 1.4%。结论　伴发病及继发病的干扰、对NPC生物学特性了解不清及隐匿性NPC为误诊的主要原因。推广纤维鼻咽镜检查及VCA IgA检测及鼻咽CT、MRI检查可减少误诊漏诊     

沙利度胺联合MP方案治疗初治多发性骨髓瘤23例

[目的]观察沙利度胺联合MP化疗方案治疗初治多发性骨髓瘤的疗效和不良反应。[方法]2004年2月至2007年1月,47例初治多发性骨髓瘤患者随机分为治疗组（n=23）和对照组（n=24）。两组患者均接受6～8周期的MP方案化疗,治疗组化疗同时接受沙利度胺口服治疗。[结果]治疗组和对照组的总有效率分别是78.3%vs50.0%（P=0.044）。两组2、3年无进展生存率及中位无进展生存时间分别是55.9%vs45.8%、21.0%vs4.2%、27个月vs23个月（P=0.048）。两组2、3年总生存率及中位生存时间分别是86.5%vs83.3%、73.7%vs48.4%、42个月vs33个月（P=0.039）。治疗组血液学毒性和肢体麻木发生率均显著性高于对照组（P〈0.05）。[结论]沙利度胺联合MP方案化疗能提高初治多发性骨髓瘤患者的生存率,延长疾病进展时间;不良反应有所增加,但能耐受。     

USe of Clodronate in Multiple Myeloma

Multiple myeloma is characterized by bone disease including osteoporosis, osteolytic lesions, pathological fractures and hypercalcaemia leading to pain, immobilization and decrease in the quality of life. Clodronate. a bisphosphonate, has been shown to be effective in the treatment of hypercalcaemia in patients with multiple myeloma. In addition, clodronate reduces the progression of osteolytic lesions and the amount of vertebral fractures and may also relieve pain in these patients. Recent studies suggest that oral clodronate should be considered in the adjunctive treatment of all patients with active multiple myeloma independently of the presence of bone lesions at diagnosis. Due to its safety and efficacy, clodronate seems to have gained an important role in the management of patients with multiple myeloma.     

多发性骨髓瘤肾损害10例临床分析

目的 :探讨多发性骨髓瘤 (multiplemyeloma ,MM)肾损害的误漏诊原因并提出避免误漏诊的要点。方法 :对 1989年 6月～ 1999年 6月住院的MM患者中 10例并肾损害者进行临床分析。结果 :首发症状缺乏特异性 ,误诊率 80 %。结论 :对于有原因不明的贫血、骨痛、蛋白尿、高球蛋白血症和骨折 ,应及时进行本周氏蛋白、免疫球蛋白及免疫电泳测定 ,多部位的骨髓穿刺和骨X线摄片 ,避免误漏诊。     

An Aggressive High Dose Cyclophosphamide and Prednisone Regimen for Advanced Multiple Myeloma

There is strong evidence that corticosteroids contribute to the objective and subjective response rate observed following treatment with several cytotoxic chemotherapy agents, and that there is a dose response effect for treatment of multiple myeloma with alkylating agents. Therefore, the Eastern Cooperative Oncology Group (ECOG) studied cyclophosphamide 600 mg/M² given for four consecutive days intravenously combined with prednisone 100 mg orally daily in 57 patients who had progressed following or failed to respond to standard doses of these drugs. Forty eight patients met the eligibility criteria for evaluation of response and toxicity. Fourteen patients (29%) had an objective response (OR) and an additional 2 (4%) had a subjective response (SR) only. The median duration of objective response was 3.1 months and estimated median survival was 8.6 months. These results are identical to our prior experience with high dose cyclophosphamide alone. The addition of prednisone does not appear to enhance results either through increased remissions or greater survival. Therefore, this study indicates that the preferred form of high dose cyclophosphamide for multiple myeloma is as a single agent given in intravenous four day courses.     

VAD-Cyclosporine Therapy for VAD-Resistant Multiple Myeloma

Few effective treatments are available for patients with multiple myeloma that is resistant to vincristine-doxorubicin by continuous infusion with high dose dexamethasone (V AD). In order to modulate p-glycoprotein, the multidrug resistance gene product, we administered a VAD-cyclosporine combination to patients with confirmed resistance to VAD. Twenty-five patients with multiple myeloma resistant to VAD received cyclosporine 4 mg/kg infused over 2 hours followed by a continuous infusion of 10 mg/kg/24 hrs for a total of 108 hours. VAD was given concurrently as a continuous infusion of vincristine 0.3 mg and doxorubicin 9 mg/m² daily for 4 days with oral dexamethasone 20 mg/m²/day for 4 days beginning on days 1,9 and 17. Clinical response and toxicity were correlated with MDR expression in plasma cells and the effects of cyclosporine on liver function. Six of 25 patients responded (24%; 958 CI 9-45%) with a median remission time of 7 months. Clinical response did not correlate with either the measured or the calculated MDR expression in plasma cells. Responses occurred more frequently in patients who developed high cyclosprine blood levels and paralytic ileus. The occasional benefit from VAD-cyclosporine for resistant multiple myeloma appeared to be due to a higher bioeffective dose of VAD rather than successful modulation of MDR.     

Hemostatic Abnormalities in Multiple Myeloma Patients

Background: Multiple myeloma (MM) is a neoplastic plasma cell disorder characterized by clonal proliferation of plasma cells in the bone marrow. Diverse hemostatic abnormalities have been reported in patients with myeloma which predispose to bleeding and also thrombosis. Methods: Complete blood count, biochemical parameters and parameters of hemostasis i.e. platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), factor VIII assay results, plasma fibrinogen, D-dimer and lupus anticoagulant, were assessed in 29 MM patients and 30 age matched controls. Results: The most frequent abnormal screening parameter was APTT. Of the six indicative of a bleeding tendency i.e. thrombocytopenia, prolonged PT, APTT, TT, reduced plasma fibrinogen and factor VIII, at least one was abnormal in 8 (27.6%) patients. Of the four prothrombotic markers, lupus anticoagulant, D-dimer, elevated factor VIII and plasma fibrinogen, one or more marker was present in 24 (82.7%). D-dimer was the most common prothrombotic marker, being elevated in 22 (75.9%) patients. One or more laboratory parameter of hemostasis was abnormal in all 29 (100%) patients. Though thrombotic complications are reported to be less frequent as compared to hemorrhagic manifestations, one or more marker of thrombosis was present in 24 (82.7%) patients. Conclusion: This study provided laboratory evidence of hemostatic dysfunction which may be associated with thrombotic or bleeding complications at diagnosis in all MM patients. Hence, screening for these abnormalities at the time of diagnosis should help improved prognosis in such cases.