Handt S, Handt S, Glöckner W M
Medizinische Klinik II, Technischen Hochschule Aachen.
Dtsch Med Wochenschr. 1993 Mar 26;118(12):410-5. doi: 10.1055/s-2008-1059343.
A 29-year-old woman, with a slightly elevated temperature for 3 weeks, increasing dyspnoea at rest, markedly reduced general condition and in heart failure, was found to have a leucocytosis of 100,000/microliters, anaemia (haemoglobin 6.3 g/dl) and thrombocytopenia (41,000/microliters). There were 62% plasma cells in the blood smear. Immunoelectrophoresis of serum and urine revealed kappa-light chains and immunocytology demonstrated IgG-kappa. There was no radiological evidence of osteolysis, while ultrasound examination showed multiple abdominal lymphomas and marked hepatosplenomegaly. Bone marrow smear showed a 90% infiltration of plasma cells. High-dosage melphalan treatment (single intravenous injection of 140 mg/m2) resulted in complete remission after myelodepression over several weeks. Two extramedullary recurrences 5 and 12 months after the diagnosis had been made were successfully treated with high-dosage melphalan, but it was associated with severe and long-lasting myelodepression. Septicaemia with renal and hepatic failure developed and the patient died 6 weeks after the third course of high-dosage melphalan, 14 months after the diagnosis.
一名29岁女性，体温轻度升高3周，静息时呼吸困难加重，全身状况明显恶化且出现心力衰竭，检查发现白细胞计数为100,000/微升，有贫血（血红蛋白6.3克/分升）和血小板减少（41,000/微升）。血涂片中有62%的浆细胞。血清和尿液免疫电泳显示κ轻链，免疫细胞学显示IgG-κ。影像学检查未发现骨质溶解证据，而超声检查显示腹部有多个淋巴瘤以及明显的肝脾肿大。骨髓涂片显示浆细胞浸润达90%。高剂量美法仑治疗（单次静脉注射140毫克/平方米）在数周的骨髓抑制后导致完全缓解。确诊后5个月和12个月出现的两次髓外复发均成功接受高剂量美法仑治疗，但伴有严重且持久的骨髓抑制。发生了伴有肾衰竭和肝衰竭的败血症，患者在第三次高剂量美法仑治疗后6周、确诊后14个月死亡。
