OSTEOBLAST STIMULATION IN MULTIPLE-MYELOMA LACKING LYTIC BONE-LESIONS
OSTEOBLAST STIMULATION IN MULTIPLE-MYELOMA LACKING LYTIC BONE-LESIONS
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DOI：
10.1111/j.1365-2141.1990.tb07904.x
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发表时间：
1990-12-01
影响因子：
6.5
通讯作者：
ALEXANDRE, C
中科院分区：
文献类型：
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作者：
BATAILLE, R;CHAPPARD, D;ALEXANDRE, C
为什么一些多发性骨髓瘤（MM）患者没有发生严重的骨丢失，甚至没有发生坐骨病变，其原因尚不清楚。为了在细胞和组织水平上回答这个问题，我们评估了10例MM患者的组织学骨状况，这些患者在疾病过程中从未发生溶骨性病变（包括2例sclerosis MM患者）。通过定量组织学（骨组织形态计量学）评价骨髓瘤诱导的骨髓瘤细胞附近的骨变化。所有10例患者均表现出成骨细胞活性显著增加。这与10例病例中7例的骨吸收增加有关。3例患者表现为纯成骨细胞。这些特征与在7例溶骨性病变患者中观察到的模式相反：骨吸收增加，骨形成减少。几乎所有这10名患者都表现出过度的成骨细胞活性，血清骨钙蛋白水平升高，这是骨形成的一种特异性标志物。最后，这些患者中有90%为λ MM（其中70%为IgG λ MM），这是一种先前与scrabine MM变体相关的免疫球蛋白亚型。总之，由于成骨细胞活性的刺激，一部分MM患者从未发生严重的骨丢失。这些患者与骨肉瘤MM属于同一家族，更常见的是IgG型和λ亚型。
The reasons why some patients with multiple myeloma (MM) do not develop severe bone loss, or even develop sclerotic bone lesions, remain unclear. In order to answer this question at the cellular and tissue level, we evaluated the histological bone condition of 10 patients with MM who never developed lytic bone lesions during the course of their disease (including two patients with sclerotic MM). Myeloma-induced bone changes in the close vicinity of myeloma cells were evaluated by quantitative histology (bone histomorphometry). All 10 patients presented a significantly increased osteoblastic activity. This was associated with an increased bone resorption in seven of the 10 cases. Three patients had a pure osteoblastic presentation. These features were the reverse of the pattern observed in seven patients with lytic bone lesions: increased bone resorption with decreased bone formation. Almost all of these 10 patients showing excessive osteoblastic activity had increased serum bone gla protein levels, a specific marker of bone formation. Finally, 90% of these patients were lambda MM (70% of them were IgG lambda MM), an immunoglobulin subtype previously associated with the sclerotic MM variants. In conclusion, a subset of patients with MM never develop severe bone loss because of the stimulation of osteoblastic activity. These patients belong to the same family as osteosclerotic MM, presenting more frequently the IgG type and lambda subtype.