夫妻同患多发性骨髓瘤2例报道并文献复习

A couple suffered from multiple myeloma:2 cases report and literature review

目的:探讨夫妻同患多发性骨髓瘤的相关危险因素。方法:报告1对夫妻同患多发性骨髓瘤的诊治经过,并结合文献复习夫妻同患癌症的相关危险因素。结果:病例1免疫球蛋白固定电泳呈IgG/LAM型,左胸壁包块免疫组化:瘤细胞EMA(+)、CD138(+)、MUM-1(+)、λ(+)、Ki-67LI80%;骨髓瘤细胞64.3%;流式细胞学免疫分型结果:表达lambda,部分表达CD38,CD138。行MPT、TD方案并联合中草药治疗可达非常好的部分缓解(VGPR)。病例2免疫球蛋白固定电泳呈IgA/LAM型;骨髓瘤细胞51%;流式细胞学免疫分型结果:表达lambda,部分表达CD38,CD56,CD138;FISH:GLPRB1位点缺失,D13S319位点缺失,JGH基因异位,1q21位点扩增,p53位点缺失可疑。行VD方案不能耐受,改为MPT方案并联合中草药治疗后可达接近完全缓解(nCR)。近10年的国内外文献中,未检索到夫妻同患多发性骨髓瘤的病例报道。夫妻癌的发生与环境、饮食、致病微生物,情志因素,基因融合,偶然性等因素相关。结论:夫妻同患多发性骨髓瘤与其长期共同的生活环境相关可能性大,但不能排除二者独立发病的巧合性。

Objective： To explore the associated risk factors of husdand and wife both suffering from multiple myelo- ma. Methods ： Report the clinical manifestations and laboratory examination data and treatment course of one couple, hus- dand and wife, both suffering from multiple myeloma, and referred to literatures in order to review the associated risk fac- tors of husband and wife both suffering cancers. Results ： Immuno electrophoresis showed IgG/LAM type in case 1, immu- nohistochemistry of mass on left chest wall：tumor cells showed EMA（ ＋ ） , CD138 （ ＋ ） , MUM-1 （ ＋ ） , k（ ＋ ） , Ki-67 LI 80% ; myeloma cell 64.3%. Flow cytometry immunophenotyping showed： expression of lambda, part of cells with expres- sion of CD38, CD138. MPT, TD programs combined with herbal treatment achieved very good partial response （VGPR）. Immunoelectrophoresis showed IgA/LAM type in case 2, myeloma cell 51% ; Flow cytometry immunophenotyping showed： expression of lambda, part with expression of CD38, CD56, CD138. FISH：GLP RB1 site miss, D13S319 site miss, JGH gene ectopy, l q21 site amplificate, p53 site suspiciously miss. Because the VD program could not be tolerated, MPT pro- gram combined with herbal treatment was used and achieved near complete response（nCR）. Nearly 10 years of domestic and foreign literatures, case report of husdand and wife both suffering from multiple myeloma have not been retrieved. Cou- ple cancer were associated with the environmental, dietary, pathogenic mieroorgarisms, emotional factors, gene fasion, contingencies and other factors. Conclusions： The long-term common living environment may play an important role in the husdand and wife both suffering from multiple myeloma, but it can not be excluded the coincidence of both incidence.