223例新诊断多发性骨髓瘤临床特点及疗效分析

The clinical features, chemotherapy responses and survival of 223 patients with newly diagnosed multiple myeloma

目的探讨我国各型多发性骨髓瘤（MM）所占比例、临床与实验室检查特点、对化疗的反应及长期生存情况。方法回顾性分析我院2000年1月至2007年9月收治的223例新诊断的各型MM的临床资料。结果IgG、IgA、轻链型、IgD、IgM和双克隆型MM分别占48．0％、20．6％、25．6％、4．0％、0．9％和0．9％，未见IgE型和不分泌型MM。中位发病年龄58岁，IgA型患者年龄最大，轻链型最小（P=0．004）。初诊时最常见的临床表现为贫血、骨痛和肾功能损害，分别占67．7％、61．0％和45．3％。轻链型与IgG和IgA型相比，肾功能损害明显，病理性骨折与高钙血症发生率高，血清蛋白电泳不出现单克隆球蛋白峰，总球蛋白多不升高。IgD型临床表现与轻链型相似。在≥4疗程的89例患者中，化疗总有效率61．8％，各型MM之间差异无统计学意义（P=0．595）。结论各型MM中，以IgG型最常见，贫血、骨痛和肾功能损害是MM患者初诊时最常见的症状。应常规行免疫固定电泳以避免漏诊轻链和IgD型多发性骨髓瘤。

Objective To explore the proportion, clinical and laboratory features, chemotherapy responses and long term survival of different kinds of newly diagnosed multiple myeloma （MM） in China. Methods The clinical data of 223 cases of newly diagnosed MM patients were gathered in the First Affiliated Hospital of Sun Yat-sen University from Jan, 2000 to Seb, 2007 were retrospectivley analyzed. Results The proportions of each kind of MM including IgG, IgA, light chain, IgD, IgM and biclonal MM were 48. 0% ,20. 6% ,25.6% ,4.0% ,0.9% and 0.9% respectively. No IgE and nonsecretary myeloma was found. The median age of onset was 58 years, of which that of the IgA type was the oldest one and the light chain type was the youngest （P =0. 004）. Bone pain, renal insufficiency, and anemia were the most common symptoms which accounted for 67.7% ,61.0% and 45. 3% respectively. The incidences of renal inadequacy, hypercalcemia and pathological fracture in light chain type were higher than those in IgG and IgA types. Besides, no M protein were found in serum protein electrophoresis and no elevation of total globulin. The cinical features of IgD type were similar to that of the light-chain type. The total chemotherapy efficacy rate of 89 patients who were treated with more than 3 cycles in our hospital is 61.8% , which has no difference in all types. Median overall survival of the 89 patients was 33.0 months. Conclusion IgG is the most common type in MM. Bone pain, anemia, hypercalcemia and renal insufficiency are common symptoms. Immunofixation electrophoresis should be performed routinely to avoid missed diagnosis of lightchain and IgD types of MM.