Autologous Hematopoietic Stem-Cell Transplantation for Multiple Myeloma
Autologous Hematopoietic Stem-Cell Transplantation for Multiple Myeloma
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DOI：
10.1056/nejmct0805626
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发表时间：
2009-06-18
影响因子：
158.5
通讯作者：
Moreau, Philippe
中科院分区：
文献类型：
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作者：
Harousseau, Jean-Luc;Moreau, Philippe
一位先前健康的59岁男性，表现为持续的腰部疼痛和疲劳。完整的血细胞计数显示，每分升的血红蛋白水平为9.8克。血清蛋白电泳法检测到一种单克隆蛋白(M组分)，经免疫固定鉴定为Ig G kappa。放射学骨骼检查显示椎骨和骨盆的弥漫性溶骨性病变。多发性骨髓瘤的诊断经骨髓抽吸证实，骨髓中有32%的浆细胞渗入。血钙和肌酐水平正常，白蛋白水平为3.7g/升，β(2)-微球蛋白水平为2.8 mg/升。骨髓浆细胞荧光原位杂交显示13号染色体缺失，无不良预后因素。考虑到患者年龄相对较小，且没有并存疾病，血液学家建议先进行诱导治疗，然后进行大剂量治疗，并将自体造血干细胞移植作为初始治疗。
A previously healthy 59-year-old man presents with persistent pain in his lower back and fatigue. A complete blood count reveals a hemoglobin level of 9.8 g per deciliter. A monoclonal protein (M component) is detected on serum protein electrophoresis and is characterized as an IgG kappa by immunofixation. A radiologic skeletal bone survey shows diffuse lytic bone lesions of the vertebrae and the pelvis. The diagnosis of multiple myeloma is confirmed by bone marrow aspiration, which reveals an infiltrate of 32% plasma cells. The serum calcium and creatinine levels are normal, the albumin level is 3.7 g per deciliter, and the beta(2)-microglobulin level is 2.8 mg per liter. Fluorescence in situ hybridization of bone marrow plasma cells shows deletion of chromosome 13, with no adverse prognostic factors. Considering the patient's relatively young age and the absence of coexisting illnesses, a hematologist recommends induction therapy followed by high-dose therapy with autologous hematopoietic stem-cell transplantation as the initial treatment.