CAJ | 학술논문

多发性骨髓瘤(MM)骨病的病理生理机制不明且较复杂.在MM早期阶段,破骨细胞的骨吸收增强,骨髓瘤细胞可能依赖骨细胞而生长和存活,随着肿瘤负荷的加重,成骨细胞引起的骨形成受抑制持续存在.骨髓形态及M蛋白仍是MM诊断的基础,鉴别克隆性浆细胞流式细胞术有优势.如果患者治疗缓解后又出现明显M蛋白复发,国际骨髓瘤工作组(IMWG)专家的共识认为需要重新开始治疗,即使新的终末器官损害证据或症状尚未出现.美法仑(M)和泼尼松(P)与沙利度胺(T)或硼替佐米(Ⅴ)组成的M PT或VMP方案是新诊断老年MM患者(不适合进行自体干细胞移植)的标准治疗选择,病情缓解后给予雷那度胺和小剂量地塞米松的方案作为后续新的标准维持治疗已逐渐被接受.在老年患者治疗时,要充分意识到老年患者的虚弱较肾功能和细胞遗传学异常更影响患者的总生存(OS),需要结合其影响制定个体化的治疗方案.
다발성골수류(MM)골병적병리생리궤제불명차교복잡.재MM조기계단,파골세포적골흡수증강,골수류세포가능의뢰골세포이생장화존활,수착종류부하적가중,성골세포인기적골형성수억제지속존재.골수형태급M단백잉시MM진단적기출,감별극륭성장세포류식세포술유우세.여과환자치료완해후우출현명현M단백복발,국제골수류공작조(IMWG)전가적공식인위수요중신개시치료,즉사신적종말기관손해증거혹증상상미출현.미법륜(M)화발니송(P)여사리도알(T)혹붕체좌미(Ⅴ)조성적M PT혹VMP방안시신진단노년MM환자(불괄합진행자체간세포이식)적표준치료선택,병정완해후급여뢰나도알화소제량지새미송적방안작위후속신적표준유지치료이축점피접수.재노년환자치료시,요충분의식도노년환자적허약교신공능화세포유전학이상경영향환자적총생존(OS),수요결합기영향제정개체화적치료방안.
Pathophysiology of myeloma bone disease is unclear and complex.At early stage,osteoclastic bone resorption is increasing,myeloma cells are dependent upon the cells of bone for growth and survival.With the increase in tumor burden,osteoblast suppression is maintained.Based on the diagnosis of multiple myeloma (MM),conventional morphology,M proteins and skeletal survey are effective approach for diagnosis and monitoring of MM.However,the multiparameter flow cytometry (MFC) has advantage in distinguishing clonal from normal plasma cells.If the patient has significant paraprotein relapse in 2 consecutive measurements separated by no more than two months,the experts of International Myeloma Working Group (IMWG) consider that myeloma therpy should be re-started,even if the symptoms or evidences of new end-organ damage has not yet appeared.For newly diagnosed MM patients who are ineligible for autologous stem cell transplantation,the combination of melphalan,prednisone and with either thalidomide (MPT) or bortezomib (VMP) is the standard treatment option,and then given with lenalidomide and low-dose dexamethasone is gradually developing a new standard continuous therapy.For elderly patients,especially over 75 years old,always have a poor clinic outcome.It should be fully aware that frailty is an independent prognostic factor which carries a greater impact on overall survival than the renal function or cytogenetic abnormalities.Therefore,it must be under consideration in developing individualized treatment programs.