摘要
目的探讨伴髓外浸润的多发性骨髓瘤（MM）的临床特点、治疗及预后。方法回顾性分析北京朝阳医院（西区）2005年5月至2010年12月收治的43例确诊为伴髓外浸润的MM患者的临床资料。在MM病程中出现髓外浸润者12例（第1组）；在MM诊断时即有髓外浸润者31例（第2组）。结果患者中位年龄53（28～76）岁，男23例，女20例。IgG型15例，IgA型9例，IgD型2例，K轻链型6例，入轻链型6例，双克隆型3例，不分泌型2例。最常浸润的部位为皮肤及肌肉软组织（39例），其次为椎管内（18例）、深部软组织（16例）。第1组中9例以硼替佐米联合DECP（顺铂、足叶乙甙、环磷酰胺、泼尼松）方案化疗的患者，2例达到完全缓解（CR），4例达到部分缓解（PR），3例疾病进展死亡；2例采用传统化疗患者，均进展死亡；1例放弃治疗后死亡。第2组中11例患者采用传统化疗，7例达PR，4例死亡；20例采用以硼替佐米为主的联合化疗，12例达CR，7例达PR，1例死亡。中位随访时间为23（5～60）个月，至随访截止，存活17例，死亡26例。第1组患者的预计3年及5年总生存率分别为54．21％、27．10％，中位生存期36（10～120）个月；第2组患者的预计3年及4年总生存率分别为39．83％、13．28％，中位生存期23（5～52）个月。结论伴髓外浸润的MM患者临床表现复杂，治疗困难，预后差，尤其是诊断时即有髓外浸润者。采用以硼替佐米为主的联合化疗虽然可以取得较好的总反应率，但长期疗效仍不佳。
Objective To explore the clinical features, treatment and prognosis of muhiple myeloma （MM） with extramedullary plasmacytomas （EM）. Methods A total of 43 patients were enrolled and divided into 2 groups. Group-1 had 12 patients of EM occurring after the diagnosis of MM while Group- 2 included 31 EM patients at the initial diagnosis of MM. Results The male-to-female proportion was 23：20 and there was a median age of 53 years. The distribution of different isotypes was IgG （n = 15 ） , IgA （n=9）, IgD （n=2）, K light chain （n=6）, k light chain （n=6）, biclonal myeloma （n=3） and nonsecretory myeloma （n = 2）. The sites of complicating plasmacytoma included skin, muscle and spinal canal. Nine patients received bortezomib plus DECP （cisplatin, etoposide, cyclophosphamide and prednisone） and 2 patients underwent traditional chemotherapy in Group-1. The outcomes were as follows： complete remission （ CR, n = 2 ）, partial remission （ PR, n = 4 ） and death （ n = 5 ）. And 11 patients received traditional chemotherapy in Group-2, 7 attained PR and 4 died. Twenty patients received bortezomib plus other chemotherapeutic drugs in Group-2. The outcomes were as follows： CR （n = 12）, PR （ n = 7） and death （n = 1 ）. The median overall survival （OS） was 36 months （range ： 10 - 120） in Group- 1 and 23 months （ range ： 5 - 52） in Group-2 respectively. In Group-1, the estimated 3- and 5-year OS were 54. 21% and 27. 10% respectively. And in Group-2, the estimated 3- and 4-year OS were 39. 83% and 13.28% respectively. Conclusions The EM patients show aggressive, complicated and diverse clinical courses and the unusual manifestation of muhiple organ involvement by plasma cells. Traditional chemotherapy has a poor efficacy and the prognosis is unfavorable, especially for EM with concurrent MM. The combined treatment of bortezomib with second-line chemotherapy may achieve curative effects.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第12期838-841,共4页
National Medical Journal of China
关键词
多发性骨髓瘤
预后
髓外浸润
临床特征
化疗
Multiple myeloma
Prognosis
Extramedullary plasmacytomas
Clinical features
Chemotherapy
