小结
定义
病史和体格检查
关键诊断因素
- 贫血
- 骨痛
- 未定性的单克隆丙种球蛋白病 (MGUS)
其他诊断因素
- 高钙血症
- 感染
- 疲劳
- 肾损害
危险因素
- 未定性的单克隆丙种球蛋白病 (MGUS)
- 异常游离轻链比
- 男性
- 黑人
- MM 的家族史
- 放射暴露
- 石油产品暴露
诊断性检查
首要检查
- 血清/尿蛋白电泳
- 血清/尿免疫固定
- 全身低剂量 CT(WBLD-CT)
- 18 氟-氟代脱氧葡萄糖-正电子发射计算机断层显像/CT(FDG-PET/CT)
- 血清游离轻链测定
- 骨髓穿刺和活检
- 血清钙
- 全血细胞计数 (FBC)
- 外周血涂片
- 肌酐、尿素
- 血清 β2 微球蛋白
- 血清白蛋白
需考虑的检查
- 全身 MRI
- 骨骼检查
- C 反应蛋白 (CRP)
- LDH
- 细胞遗传学分析(荧光原位杂交 [FISH])
- 质谱分析
治疗流程
初诊移植候选人(< 65~70 岁,体能状态良好)
新诊断的非移植候选人(>65-70 岁和/或体力状态较差)
对初始治疗应答的符合移植条件和不符合移植条件的患者
复发或难治性患者
撰稿人
作者
Loredana Santo, MD
Research Fellow
Massachusetts General Hospital
Harvard Medical School
Boston
MA
利益声明
Not disclosed.
Matthew M. Lei, PharmD
Clinical Pharmacist Medical Oncology
Massachusetts General Hospital
Boston
MA
利益声明
MML declares that he has no competing interests. MML is an author of a reference cited in this topic.
Noopur Raje, MD
Director of Multiple Myeloma Program
Massachusetts General Hospital
Harvard Medical School
Boston
MA
利益声明
NR has received institutional research funding from Amgen, bluebird bio, Janssen, Caribou, Bristol Myers Squibb, and Celgene. NR is an author of several references cited in this topic.
鸣谢
Dr Loredana Santo, Dr Matthew M. Lei, and Dr Noopur Raje would like to gratefully acknowledge Dr Sonia Vallet, a previous contributor to this topic.
利益声明
SV declares that she has no competing interests.
同行评议者
Shaji Kumar, MD
Associate Professor of Medicine
Mayo Clinic
Rochester
MN
利益声明
SK declares that he has no competing interests.
Faith Davies, MD
Institute of Cancer Research
Sutton
Surrey
UK
利益声明
FD declares that she has no competing interests.
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