摘要
目的：综述多发性骨髓瘤伴髓外浆细胞瘤的诊治进展。方法：收集近年国内外发表的相关文章并对多发性骨髓瘤（MM）合并髓外浆细胞病（EMD）的发病情况、预后及治疗进展进行分析。结果与结论：根据病例研究MM诊断时EMD的发生率为7%～18%，复发时可达6%～20%。发生髓外进展的患者预后较差，生存期短。目前对于MM伴髓外病变的治疗没有明确的最佳方案。髓内病变稳定而出现单个髓外浆细胞瘤的患者可行放疗，MM系统复发并出现髓外病变的患者应行化疗。年轻患者进行大剂量治疗加自体干细胞移植可克服髓外病变带来的不利预后的影响。单药沙利度胺治疗EMD无反应，但与其他药物联合化疗可能有效。可能有效的一线治疗方案为含硼替佐米方案和含来那度胺的联合化疗方案，如果可能随后进行自体造血干细胞移植（ASCT）。
Objective： To review the research progress of multiple myeloma with extramedul ary plasmacytoma in diagnose and treatment. Methods：We col ected articles related to multiple myeloma＆amp;nbsp;（MM） with with extramedullary plasmacytoma published in recent years through Pubmed and CNKI and analyzed the incidence of the disease and diagnosis and therapeutic progress . Results and Conclusion： Incidence of plasmacytoma associated with MM at diagnosis were 7%to 18% depending on studies, while the occurrence rate of extramedul ary disease during the course of myeloma were 6%to 20%. Extramedul ary progression of MM has consistently been associated with a poor disease prognosis. Data about the preferred systemic treatment are scarce and are not based on direct comparisons. Local radiotherapy could be used in myeloma patients with solitary plasmacytoma while systematic myeloma is stable. Patients with systemic relapse myeloma and plasmacytoma should be given combination chemotherapy. High-dose therapy with autologous stem-celltransplantation （ASCT） can overcome the negative prognostic impact of extramedul ary disease in younger selected patients. EMPs do not typical y respond to thalidomide alone, but responses to thalidomide-containing regimen have been reported. A potential first-line treatment option seems to be a bortezomib-containing and lenalidomide-containing combination regimen fol owed by ASCT, whenever possible.
出处
《临床药物治疗杂志》
2014年第2期29-34,共6页
Clinical Medication Journal
关键词
髓外浆细胞瘤
多发性骨髓瘤
诊治
Extramedul ary plasmacytoma
Multiple myeloma
Diagnose and Treatment
