Updated Diagnostic Criteria and Staging System for Multiple Myeloma.
Updated Diagnostic Criteria and Staging System for Multiple Myeloma.
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DOI：
10.14694/edbk_159009
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发表时间：
2016-01-01
期刊：
影响因子：
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通讯作者：
Rajkumar, S Vincent
中科院分区：
文献类型：
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作者：
Rajkumar, S Vincent
多发性骨髓瘤（MM）的诊断和治疗已经取得了显著的进展。由于几种新的活性药物，这种疾病的中位生存期增加了一倍。这些进展使得对MM的疾病定义和分期进行修订成为必要。直到最近，MM被定义为终末器官损伤的存在，特别是高钙血症、肾功能衰竭、贫血和骨病变（螃蟹特征），这些可归因于克隆过程。2014年，国际骨髓瘤工作组（International Myeloma Working Group， IMWG）更新了MM的诊断标准，增加了3个特异性生物标志物，可用于无CRAB特征的患者的诊断：克隆骨髓浆细胞大于或等于60%，血清游离轻链（FLC）比大于或等于100（前提是涉及的FLC水平为100mg /L或更高），或MRI上有一个以上局灶性病变。此外，对定义进行了修订，允许CT和PET-CT诊断MM骨病。这些变化使早期诊断成为可能，并允许开始有效的治疗，以防止风险最高的患者发生终末器官损伤。一种新的分期系统已经开发出来，除了标准的预后实验室标记外，还包括高危细胞遗传学异常。
There has been remarkable progress made in the diagnosis and treatment of multiple myeloma (MM). The median survival of the disease has doubled as a result of several new active drugs. These advances have necessitated a revision of the disease definition and staging of MM. Until recently, MM was defined by the presence of end-organ damage, specifically hypercalcemia, renal failure, anemia, and bone lesions (CRAB features) that can be attributed to the clonal process. In 2014, the International Myeloma Working Group (IMWG) updated the diagnostic criteria for MM to add three specific biomarkers that can be used to diagnose the disease in patients who did not have CRAB features: clonal bone marrow plasma cells greater than or equal to 60%, serum free light chain (FLC) ratio greater than or equal to 100 provided involved FLC level is 100 mg/L or higher, or more than one focal lesion on MRI. In addition, the definition was revised to allow CT and PET-CT to diagnose MM bone disease. These changes enable early diagnosis and allow the initiation of effective therapy to prevent the development of end-organ damage for patients who are at the highest risk. A new staging system has been developed that incorporates high-risk cytogenetic abnormalities in addition to standard laboratory markers of prognosis.