多发性骨髓瘤的预后与分层策略

Prognosis and stratification strategies of multiple myeioma

多发性骨髓瘤（MM）是一种高度异质性的浆细胞恶性肿瘤。染色体高度不稳定及复杂的遗传学异常为MM细胞的生物学特征，亦为最重要的预后因素。在发病初期，MM细胞发生奇数染色体三体或免疫球蛋白（Ig）H基因重排，逐步积累基因片段的扩增或缺失，获得恶性的增殖力、侵袭力及耐药性，导致MM患者预后不佳。笔者拟就MM的临床、遗传学、影像学等多方面对其预后指标进行介绍，分析现有分层系统的优势与不足，并探讨合理的预后分层策略。

Multiple myeloma （MM） is a highly heterogeneous plasma cell malignant disorder. Regarded as specific biological features of MM, chromosome instability and cytogenetic abnormality are the strongest indicators of impaired survival. At early stage of MM, tumor cells usually undergo odd chromosome trisomies or immunoglobulin fig） H translocations, and pile up secondary gene amplifications and deletions, evolving into a more proliferative, invasive, and drug-resistant stage. And MM patients have poor prognosis. The author will summarize various prognostic markers from clinical, genetic and imagiological aspects, analyze the advantages and disadvantages of current staging systems, and discuss the reasonable stratification strategy.