Division of Endocrinology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Oncology (Williston Park). 2009 Dec;23(14 Suppl 5):28-32.
Multiple myeloma is a uniformly fatal hematologic malignancy that results from the clonal expansion of plasma cells within the bone marrow. Skeletal-related complications affect nearly all patients with multiple myeloma and have a major impact on both patient morbidity and mortality. These complications most frequently include the development of osteolytic lesions that lead to severe bone pain, hypercalcemia, and pathologic fractures. Comprehensive skeletal imaging, using first plain radiographs and then more advanced modalities if necessary, is critical both at the time of diagnosis and throughout the course of therapy to assess the skeletal impact of the disease. The widespread use of intravenous bisphosphonate therapy has significantly improved the quality of life of myeloma patients by limiting the amount of osteolytic destruction that occurs. Bisphosphonate treatment, however, does not lead to repair of bone damage that has already occurred. The recent identification of multiple molecular targets with key roles in the osteolytic process has illuminated our understanding of myeloma bone disease, and may transform our future approaches to providing multiple myeloma patients with optimal skeletal care.
多发性骨髓瘤是一种均匀致命的血液系统恶性肿瘤，源于骨髓中浆细胞的克隆性扩张。骨骼相关并发症几乎影响所有多发性骨髓瘤患者，对患者的发病率和死亡率都有重大影响。这些并发症最常包括溶骨性病变的发展，导致严重的骨痛、高钙血症和病理性骨折。全面的骨骼成像，首先使用普通 X 光片，如果需要，然后使用更先进的方式，在诊断时和整个治疗过程中都至关重要，以评估疾病对骨骼的影响。静脉注射双膦酸盐治疗的广泛应用，通过限制溶骨性破坏的发生，显著提高了骨髓瘤患者的生活质量。然而，双膦酸盐治疗并不能导致已经发生的骨损伤的修复。最近，多个分子靶点的鉴定在溶骨性过程中具有关键作用，这阐明了我们对骨髓瘤骨病的理解，并可能改变我们未来为多发性骨髓瘤患者提供最佳骨骼护理的方法。
