Multiple myeloma: from diagnosis to treatment.
Multiple myeloma: from diagnosis to treatment.
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发表时间：
2013-10
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通讯作者：
R. Eslick;D. Talaulikar
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作者：
R. Eslick;D. Talaulikar
背景多发性骨髓瘤的特征是骨髓内恶性浆细胞的增殖，产生异常的单克隆副蛋白和终末器官损伤的证据。目的多发性骨髓瘤的诊断具有挑战性，本文重点介绍了诊断中的问题，并提供了管理的概述。讨论多发性骨髓瘤可表现出多种症状，包括高钙血症、贫血、肾损害和/或骨痛。这些症状的组合，特别是如果意外或无法解释，应提示骨髓瘤的诊断评估。浆细胞疾病的检查包括确定是否存在单克隆副蛋白、基线血液和放射学检查。需要血液学转诊进行骨髓活检和持续管理。较新的治疗方法，如免疫调节剂沙利度胺或来那度胺，或蛋白酶体抑制剂硼替佐米，与类固醇和偶尔的细胞毒性药物联合使用，改善了骨髓瘤患者的预后。自体干细胞移植是提供给年轻患者很少合并症。一些患者接受沙利度胺或来那度胺维持治疗。
BACKGROUND Multiple myeloma is characterised by the proliferation of malignant plasma cells within the bone marrow, which produce an abnormal monoclonal paraprotein and evidence of end organ damage. OBJECTIVE Multiple myeloma can pose a diagnostic challenge and this article highlights issues in diagnosis and provides an overview of management. DISCUSSION Multiple myeloma can present with a wide constellation of symptoms including hypercalcaemia, anaemia, renal impairment and/or bony pain. A combination of these symptoms, particularly if unexpected or unexplained, should prompt diagnostic evaluation for myeloma. Work up of plasma cell disorders involves establishing the presence of a monoclonal paraprotein, baseline bloods and radiological investigations. Haematology referral is required for bone marrow biopsy and ongoing management. Newer treatments such as the immunomodulators thalidomide or lenalidomide, or the proteasome inhibitor bortezomib, administered in combination with steroids and occasionally cytotoxic agents have improved outcomes in patients with myeloma. Autologous stem cell transplant is offered to younger patients with few comorbidities. Some patients are offered maintenance therapy with thalidomide or lenalidomide.