多发性骨髓瘤终末期患者84例临床资料总结

A report of eighty-four multiple myeloma patients at end-stage

目的分析多发性骨髓瘤（MM）终末期患者的临床特点，以指导临床采用最佳的治疗策略。方法选择1994年1月至2007年7月诊治的84例终末期MM病例，总结其临床特点并复习相关文献。结果终末期患者以骨痛为主诉最为常见（61．9％），双膦酸盐可以有效缓解患者的骨痛症状；所有患者均存在耐药现象，包括原发耐药与继发耐药，原发耐药者预后不佳，中位生存期仅11个月（7。14个月），而继发耐药者中位生存期为46（12～87）个月（P〈0．01）；感染、血细胞减少、低蛋白血症、肾功能不全、电解质紊乱、心功能不全、出凝血机制异常是MM患者的主要临床特征，而高钙血症少见（4．8％）。继发浆细胞白血病、髓外浸润（颅内、椎管内、浆膜腔等）、继发第二肿瘤等患者对治疗反应差，生存期短。结论加强支持治疗对于终末期MM患者极为重要，需要进一步研究治疗MM的新方案。

Objective To analyze the characteristics of multiple myeloma（MM） patients at end-stage in order to introduce optimal therapeutic strategies for MM. Methods The clinical features of 84 end-stage multiple myeloma patients were analyzed and related literatures were reviewed. Results The pain in bone was the main complaint in 61.9 % patients and bisphosphonates could treat bone disease effectively. Drug resistance including primary and secondary displayed in all patients. The primary drug resistance had a poor prognosis with median survival of only 11 months （range 7-14 months） and the secondary of 46 months （range 12-87 months）（P 〈0.01）. The main abnormal characteristics were infection, hematocytopenia, hypoproteinemia, renal inadequacy, electrolyte disturbances, cardiac inadequacy and abnormity of hemostasis and thrombosis. But hypoproteinemia was a rare event（4.8 %）. The patients who suffered from secondary plasmacytic leukemia, extramedullary tumor （intracal, canalis spinalis and serous cavity et al） and secondary tumor had a poor response to treatment and a shorter survival duration. Conclusion MM at end-stage has a poor prognosis and effective supportive therapies are very important for those patients. New strategies should be applied to those patients.