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目的:探讨多发性骨髓瘤(MM)克隆演变的临床特点、生物学特征和预后。方法:报告1例在治疗过程中发生克隆演变的MM患者的临床、实验室特征、治疗经过、克隆演变特点、预后,并结合文献复习进行讨论。结果:患者骨髓浆细胞占25%,免疫固定电泳单克隆IgAκ(IgA 15.9 g/L),有多处骨质破坏,Durie-Salmon分期为ⅢB期。包括沙利度胺、硼替佐米等方案化疗4个疗程后达部分缓解。巩固化疗过程中,M蛋白(IgA)和血κ轻链下降的同时,出现肝脏、脾脏、皮肤等髓外浸润,伴血β2微球蛋白升高、骨髓MM细胞比例增加和骨髓MM细胞形态改变,后续强烈化疗无效,病情快速进展,1个月后死于多器官功能衰竭。结论:MM在治疗过程中M蛋白下降的同时出现肿瘤负荷增加,提示可能发生克隆演变,常伴髓外浸润,对治疗不敏感,预后差。
Objective: To investigate the clinical features, biological characteristics and prognosis of multiple myeloma (MM) clones. METHODS: The clinical, laboratory characteristics, treatment course, clonal evolution, prognosis of 1 MM patient with clonogenic evolution during the course of treatment were reported and discussed in combination with literature review. Results: The bone marrow cells accounted for 25%, IgA (IgA15.9 g / L) was immobilized on the immunostaining gel. There were multiple bone destruction and Durie-Salmon stage ⅢB. Including thalidomide, bortezomib and other chemotherapy regimens after the four courses of partial remission. In the course of consolidation of chemotherapy, extramedullary infiltration of liver, spleen and skin, increase of serum β2-microglobulin, increase of bone marrow MM cell ratio and change of bone marrow MM cell morphology were observed at the same time when M protein (IgA) and blood κ light chain decreased Follow-up strong chemotherapy ineffective, rapid progression, died of multiple organ failure after 1 month. CONCLUSION: Increasing tumor burden of M protein during treatment of MM suggests that clonality may occur, often accompanied by extramedullary infiltration, which is not sensitive to treatment and has a poor prognosis.