摘要
多发性骨髓瘤(MM)伴髓外病变(EMD)的发病率和发现率逐年升高。EMD包括三种类型:①骨髓瘤侵及邻近骨皮质并通过局部生长形成软组织包块;②不与骨相连的软组织肿块或内脏肿块,通过血行转移至骨髓远处器官或组织,表现为单一或多发的的结节或肿块;③骨髓瘤细胞弥漫浸润器官而没有局灶性病变,如胸水等。骨髓微环境通过引起信号分子级联反应介导骨髓瘤细胞增殖、转移、存活,促使骨髓瘤生长和恶性浆细胞归巢。伴EMD的MM患者总体生存期短、预后差。治疗上可选择蛋白酶体抑制剂联合IMiDs,VTD/-PACE、单抗Dara、elotuzumab、抗BCMA、BCL-2靶向药物等,也可以考虑allo-SCT或序贯ASCT。
The incidence of multiple myeloma(MM)with extramedullary disease(EMD)has increased. There are three types of EMD clinically:(1)Tumor mass adjacent to bone and extending into soft tissue.(2)A soft tissue mass or visceral mass not connecting to the bone;and metastasis to distant organs or tissues of the bone marrow by blood,manifesting as a single or multiple nodule or mass.(3) Myeloma cells diffuse into organs without focal lesions,such as pleural effusion. The bone morrow microenvironment plays a key role in the proliferation,transfer,homing and survival of plasmocyte. The survival time of patients with EMD is short and the prognosis is poor. Proteasome inhibitors combined with IMi Ds,VTD/-PACE,monoclonal antibodies Dara,elotuzumab,antiBCMA,BCL-2 targeted drugs can be selected for treatment,allo-SCT or sequential ASCT can also be considered.
作者
李新
黄仲夏
LI Xin;HUANG Zhong-xia(Beijing Chao-yang Hospital,Capital Medical University,Beijing 100043,China)
出处
《肿瘤学杂志》
CAS
2020年第2期86-91,共6页
Journal of Chinese Oncology
基金
北京市科技计划课题(Z171100000417010)
北京市石景山区医学重点扶持专科建设项目(20170006).
关键词
多发性骨髓瘤
髓外病变
预后
治疗
multiple myeloma
extramedullary disease
prognosis
treatment
