7例少见类型多发性骨髓瘤及文献复习

Rare types of multiple myeloma in 7 cases and literature review

目的探讨少见类型多发性骨髓瘤(MM)的临床特征。方法选择宁夏回族自治区人民医院2012年1月至2017年6月诊断的7例少见类型MM的病例,对其进行实验室检查和骨髓形态学及流式细胞术检查。因硼替佐米价格昂贵,7例患者均选择给予沙利度胺口服联合长春新碱+吡柔比星+地塞米松(VTD)方案治疗,出院期间均给予环磷酰胺+沙利度胺+地塞米松(CTD)方案维持。结果例1为IgG-KAP/IgALAM型,例2为IgG-KAP/KAP型,例3为IgG-KAP/IgA-KAP型,例4为IgG-LAM/LAM型M蛋白血症,例5为分泌三克隆免疫球蛋白的MM(IgG-KAP/IgG-LAM/LAM),例6为IgD型MM,例7为IgM型MM。2例(例1,例2)患者在治疗半年后另一M蛋白消失,除例3患者死亡外,目前其余6例患者仍在治疗中。结论分泌双克隆及三克隆免疫球蛋白及IgD、IgM型的MM非常少见,临床表现多样。

Objective To explore the clinical features of rare types of multiple myeloma(MM).Methods Seven cases of rare types of MM diagnosed in Ningxia Hui Autonomous Region People′s Hospital from January 2012 to June 2017 were selected and conducted the laboratory detection,bone marrow morphology and enchantment process cytometry examinations.Because bortezomib was too expensive,7 cases were treated with thalidomide orally combined with VTD regimen(vincristine+pirarubicin+dexamethasone),maintained with CTD regimen(cyclophosphamide+thalidomide+dexamethasone)during discharge period.Results Case 1 was the type IgG-KAP/IgA-LAM,case 2 was the type IgG-KAP/KAP,case 3 was the type IgG-KAP/IgA-KAP,case 4 was the type IgG-LAM/LAM,case 5 was MM secreting three clone immunoglobulin(IgG-KAP/IgG-LAM/LAM),case 6 was the type IgD MM,case 7 was the type IgM MM.Two cases(case 1 and case 2)had another M protein disappearance after 6-months treatment,at present excepting the death of case 3,other 6 cases were still in the treatment.Conclusion MM secreting double clone and three clone immunoglobulin MM and IgD and IgM types of MM are clinically rare,which needs more cases to summarize.