Eslick Renee, Talaulikar Dipti
BMed, Haematology Advanced Trainee, Department of Haematology, Canberra Hospital, Canberra, Australian Capital Territory.
Aust Fam Physician. 2013 Oct;42(10):684-8.
Multiple myeloma is characterised by the proliferation of malignant plasma cells within the bone marrow, which produce an abnormal monoclonal paraprotein and evidence of end organ damage.
Multiple myeloma can pose a diagnostic challenge and this article highlights issues in diagnosis and provides an overview of management.
Multiple myeloma can present with a wide constellation of symptoms including hypercalcaemia, anaemia, renal impairment and/or bony pain. A combination of these symptoms, particularly if unexpected or unexplained, should prompt diagnostic evaluation for myeloma. Work up of plasma cell disorders involves establishing the presence of a monoclonal paraprotein, baseline bloods and radiological investigations. Haematology referral is required for bone marrow biopsy and ongoing management. Newer treatments such as the immunomodulators thalidomide or lenalidomide, or the proteasome inhibitor bortezomib, administered in combination with steroids and occasionally cytotoxic agents have improved outcomes in patients with myeloma. Autologous stem cell transplant is offered to younger patients with few comorbidities. Some patients are offered maintenance therapy with thalidomide or lenalidomide.
多发性骨髓瘤的特征是骨髓内恶性浆细胞增殖，这些细胞产生异常单克隆副蛋白并伴有终末器官损害的证据。
多发性骨髓瘤可能带来诊断挑战，本文重点介绍诊断方面的问题并概述治疗方法。
多发性骨髓瘤可表现出多种症状，包括高钙血症、贫血、肾功能损害和/或骨痛。这些症状的组合，尤其是如果出乎意料或无法解释时，应促使对骨髓瘤进行诊断评估。浆细胞疾病的检查包括确定单克隆副蛋白的存在、进行基础血液检查和影像学检查。骨髓活检和后续治疗需要血液科转诊。新型治疗方法，如免疫调节剂沙利度胺或来那度胺，或蛋白酶体抑制剂硼替佐米，与类固醇联合使用，偶尔也与细胞毒性药物联合使用，已改善了骨髓瘤患者的治疗效果。自体干细胞移植适用于合并症较少的年轻患者。一些患者接受沙利度胺或来那度胺维持治疗。
