课件：多发性骨髓瘤早期诊断和治疗讲诉.ppt

* Recommendations: X Treatment should be delayed until there are signs of progression in patients with equivocal/indolent/smouldering myeloma and no bone lesions (Grade A recommendation; level Ib evidence). Such patients must, however, be carefully monitored by 3 monthly physical examination, and measurement of both serum and urinary paraprotein. Repeat bone marrow examinations and skeletal X-rays will be required less often or when new symptoms or signs develop (Grade C recommendation; level IV evidence) * Recommendations: X Treatment should be delayed until there are signs of progression in patients with equivocal/indolent/smouldering myeloma and no bone lesions (Grade A recommendation; level Ib evidence). Such patients must, however, be carefully monitored by 3 monthly physical examination, and measurement of both serum and urinary paraprotein. Repeat bone marrow examinations and skeletal X-rays will be required less often or when new symptoms or signs develop (Grade C recommendation; level IV evidence) * * * * * * * P13 * * * * * * * * * Progression on or within 60 days of completing last therapy Median time to progression and survival decreases with number of prior therapies Mayo Clinic database (1985 – 1998), Blood 2002 Kumar et al. 44th Annual Meeting of the American Society of Hematology, 2002; Philadelphia, PA Abstract 2352 * * * * * * 不同分期标准的比较 Original Durie/Salmon myeloma staging system Durie/Salmon plus International staging system(ISS) Median survival(months) Median survival(months) Median survival(months) STAGEⅠ A 69 72 Ⅰ 62 B 22 20 STAGEⅡ A 58 61 Ⅱ 44 B 34 28 STAGEⅢ A 45 40 Ⅲ 29 B 24 19 八、临床治疗效果 2009-2-18 天使工程血液系统肿瘤专科学习班 治疗现状 复发 疗效短暂 生存期 1-3年 诊断 生存期 3-5 年 生存期 12个月 不治疗 复发及难治 对所有治疗抵抗 通常为致死性 生存 6-9个月 一线 ： VAD MP 移植 5年死亡率: 75%; 10年死亡率: 95-98% 二线 ： 难治: 支持或姑息治疗 试验性治疗. 缓解率50 - 75% 全部会复发 临床需要有效的治疗方法 复发后的治疗取决于缓解时间和既往治疗。缓解率和持续时间随方案的序贯应用而递减 研 究 病例 方案 CR/nCR CR+PR 干细胞 采集 参考文献 Rajkumar 100 Dex 0% 50% Yes JCO 2006 Goldschmidt 203 VAD 3