mm的发病及治疗进展ppt课件.ppt

* * * CI：置信区间，可信区间 PFS:无疾病生存期，从首次万珂给药至癌症进展或死亡的日期 PFS率：无疾病生存率 * MGUS Many workers consider this to be premalignant although many patients are stable and do not progress to myeloma. IgG in 75%, IgM in 15% and IgA in 10%. Approximately 25% of patients with MGUS develop plasma cell myeloma, primary amyloidosis, macroglobulinaemia, or other !ymphoproliferative disease after follow-up for more than 20 years. The actuarial risk of malignant transformation is unrelated to the type of M-protein. The median interval from the recognition of the M-protein to diagnosis of myeloma, macroglobulinaemia, or amyloidosis is approximately 10 years. Thus, patients with MGUS must be followed indefinitely for evidence of progressive disease. Smouldering myeloma These patients have higher levels of M-component and marrow plasmacytosis than patients with MGUS, and fulfil the minimal criteria for the diagnosis of plasma cell myeloma, but are asymptomatic and have no lytic bone lesions or other clinical features of rnyeloma, including anaemia, renal insufficiency, or hypercalcaemia, A small M-protein may be found in the urine and the concentration of normal serum immunoglobulins is often reduced. In some patients, symptomatic plasma cell myeloma does not develop for years. These patients are typically not treated unless progression occurs. Indolent Myeioma This variant is similar to smouldering myeloma in that the diagnostic criteria for plasma cell myeloma are met but differs from it in that the patients have up to three lytic bone lesions, without bone pain the M-protein is at intermediate levels like smouldering myeloma the patients have a normal Hb, serum calcium and creatinine there is no evidence of infection. As with smoldering myeloma these patients are typically not treated but are followed until symptoms develop * * Durie?Salmon系统基于以下四个因素： 血清或尿中M蛋白的数量 高水平M蛋白提示肿瘤负荷高 血钙数量 高血钙水平发生在进展性骨骼破环时 血中血红蛋白数量 低血红蛋白水平表明骨髓被骨髓瘤细胞代替，排挤正常红细胞前体细胞 溶骨性病变的数量 溶骨性病变的数量随疾病进展和肿瘤负荷增加而增加 * * * * Test