多发性骨髓瘤究进展和治疗选择.ppt

New Developments and Treatment Options for Multiple Myeloma Robert Z. Orlowski, MD, PhD Mary Elizabeth Thomas Associate Professor of Medicine, Division of Hematology/Oncology Associate Professor, Department of Pharmacology 多发性骨髓瘤研究进展和治疗选择 Robert Z. Orlowski, MD, PhD Mary Elizabeth Thomas Associate Professor of Medicine, Division of Hematology/Oncology Associate Professor, Department of Pharmacology Outline Diagnosis, staging and risk identification Initial therapy in newly diagnosed myeloma patients Novel options for patients in the relapsed and/or refractory setting Representative case presentations of current myeloma treatment algorithms 内容大纲 诊断，分期，及风险评估 初治骨髓瘤病人的初始治疗 复发和/或难治性病人的新选择 当前骨髓瘤治疗法则的代表性病例分析 Diagnostic Criteria Major Criteria 1. Plasmacytoma on tissue biopsy 2. Bone marrow plasmacytosis 30% 3. Monoclonal serum protein 3.5 g/dL IgG 2.0 g/dL IgA 1.0 g/24 hrs k or l light chain in urine Minor Criteria A. Bone marrow plasmacytosis 10-30% B. Smaller monoclonal spike than in major criterion #2 C. Lytic bony lesions D. Depressed normal Igs IgM 500 mg/dL IgA 1 g/dL IgG 6 g/dL 诊断标准 主要标准 1. 组织活检证实有浆细胞瘤 2. 骨髓浆细胞增多 30% 3. 过量血清M蛋白 3.5 g/dL IgG 2.0 g/dL IgA 尿中k 或 l轻链 1.0 g/24小时 次要标准 A. 骨髓浆细胞增多 10-30% B. M蛋白未达主要标准的第3项 C. 溶骨性病变 D. 正常 Igs 降低 IgM 500 mg/dL IgA 1 g/dL IgG 6 g/dL Arriving at the Diagnosis Two major criteria One major + one minor criterion 1+B, 1+C, 1+D 2+B, 2+C, 2+D 3+A, 3+C, 3+D Three minor criteria that include A and B A+B+C, A+B+D 确诊条件 2个主要标准 1个主要 + 1个次要标准 1+B, 1+C, 1+D 2+B, 2+C, 2+D 3+A, 3+C, 3+D 包含A及B的三个次要标准 A+B+C, A+B+D Problems with This Method Criteria are cumbersome Difficult to use for patients and physicians The boundaries are arbitrary 31% marrow plasmacytosis is a major criterion while 29% isn’t, but are these really different? Some patients may “fall through the cracks” A patient with multiple painful lytic lesions may not meet criteria, but needs systemic therapy 40% of symptomatic patients have an M-protein of 30 g/L, and 5% have 10% marrow