多发性骨髓瘤病例分享 - 安庆市立医院.ppt

多发性骨髓瘤诊断标准 分期 治疗 初治患者传统化疗的缓解率欠佳 * First rajkumar line is lighter blue. Why? REFERENCES Jagganath S, et al. ASH 2005. Abstract 783. (Note: did not find ref in BrJh in pubmed). CR+nCR+PR listed in abstract as 85%. (GK) Not sure where Gordon is getting his information-89% is accurate according to the ASH presentation………… (AB) Harousseau J, et al. ASCO 2005. Abstract 6653. Abstract lists CR as 17% and ORR as 80%. (GK). Gordon, please check slides next time… numbers are correct (AB) Rajkumar SV, et al. J Clin Oncol. 2006;24(3):334-336. Abstract does not mention 4% CR/nCR rate, says 63% is response rate. (GK) Seems OK to me (AB) Rajkumar SV, et al. Blood. 2005;106(13):4050-4053. Numbers match abstract! (GK) this is good news (AB) Nievizky. No author with this name listed in for ASH 2004 or 2005. Possibly misspelled? (GK) YES, this is Dr. Niesvizky from Cornell. BUT I can’t find it – possibly related to abstract 3454??...Yes there is….it is spelled Niesvizky and it is abstract 3454…..RSM….No changes made to this slide…RSM 多发性骨髓瘤病例分享 安庆市第一人民医院血液科 徐珍琴/朱爱萍 病史介绍 患者，女，67岁，农民。 因左侧臀部阵发性疼痛，活动时加重，并出现跛行。 查体：神清，浅表淋巴结未触及肿大，胸骨无压痛，心率：53次/分，律齐未闻及病理性杂音，双肺呼吸音粗，未闻及干湿性罗音，腹软，肝脾未触及，双下肢无浮肿。 辅助检查 尿本周氏蛋白阴性， 尿Kappa链：943mg/dl.Lambda:30mg/dl.血轻链正常。 PET-CT:颅骨、多发肋骨、肩胛骨、骶骨、坐骨多发结节状FDG代谢异常增高。结合病史，考虑多发性骨髓瘤。 辅助检查 Β2微球蛋白：6.7mg/L, IgA:0.86g/L,IgG:53.4g/L,IgM:1.38g/L. 肝肾功能、电解质未见异常。D-二聚体：7.6mg/L, 血常规：80g/l 辅助检查 2013.05.24骨髓细胞学：骨髓有核细胞增生明显活跃，粒系增生减低，浆细胞增生活跃，占有核细胞的20.5%，其中幼稚浆细胞占5.5%，可见少数双核等形态浆细胞，红系增生活跃，血小板散在可见。 辅助检查 诊断为IgG-κ 治疗 日期 治疗方案 2013.05.-2013.08 沙利度胺100mQN+地塞米松15mgqd*4 2013.08.07 硼替佐米2.72mg，biw*2周+沙利度胺+地塞米松 2013.09.24 沙利度胺+地塞米松 2013.11.18 硼替佐米1.75mg，皮下，tiw*1周+沙利度胺+地塞米松 每月使用唑来膦酸4mg静滴一次 治疗后复查 2013.05.23 2013.08.05 2013.09.24 2013.11.17 2013.12.11 血红蛋白 80g./l 99g/l 112g/l 94g/l 110g/l 血κ 642mg/dl 570mg/dl 344mg/dl 1430mg/dl 776mg/dl 血λ 264mg/dl 284mg/dl 160mg/dl 722mg/dl 440mg/dl 尿κ 943mg/dl 867mg/dl 154mg/dl 984mg/dl 12mg/dl 尿λ 30mg/dl 24mg/dl 5mg/dl 20mg/dl 5mg/dl 骨骼平片