临床药物治疗杂志
臨床藥物治療雜誌
림상약물치료잡지
CLINICAL MEDICATION JOURNAL
2014年
2期
29-34
,共6页
髓外浆细胞瘤%多发性骨髓瘤%诊治
髓外漿細胞瘤%多髮性骨髓瘤%診治
수외장세포류%다발성골수류%진치
Extramedul ary plasmacytoma%Multiple myeloma%Diagnose and Treatment
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）。
目的：綜述多髮性骨髓瘤伴髓外漿細胞瘤的診治進展。方法：收集近年國內外髮錶的相關文章併對多髮性骨髓瘤（MM）閤併髓外漿細胞病（EMD）的髮病情況、預後及治療進展進行分析。結果與結論：根據病例研究MM診斷時EMD的髮生率為7%～18%，複髮時可達6%～20%。髮生髓外進展的患者預後較差，生存期短。目前對于MM伴髓外病變的治療沒有明確的最佳方案。髓內病變穩定而齣現單箇髓外漿細胞瘤的患者可行放療，MM繫統複髮併齣現髓外病變的患者應行化療。年輕患者進行大劑量治療加自體榦細胞移植可剋服髓外病變帶來的不利預後的影響。單藥沙利度胺治療EMD無反應，但與其他藥物聯閤化療可能有效。可能有效的一線治療方案為含硼替佐米方案和含來那度胺的聯閤化療方案，如果可能隨後進行自體造血榦細胞移植（ASCT）。
목적：종술다발성골수류반수외장세포류적진치진전。방법：수집근년국내외발표적상관문장병대다발성골수류（MM）합병수외장세포병（EMD）적발병정황、예후급치료진전진행분석。결과여결론：근거병례연구MM진단시EMD적발생솔위7%～18%，복발시가체6%～20%。발생수외진전적환자예후교차，생존기단。목전대우MM반수외병변적치료몰유명학적최가방안。수내병변은정이출현단개수외장세포류적환자가행방료，MM계통복발병출현수외병변적환자응행화료。년경환자진행대제량치료가자체간세포이식가극복수외병변대래적불리예후적영향。단약사리도알치료EMD무반응，단여기타약물연합화료가능유효。가능유효적일선치료방안위함붕체좌미방안화함래나도알적연합화료방안，여과가능수후진행자체조혈간세포이식（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 (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.
