多发性骨髓瘤的克隆异质性与克隆演变

Clonal heterogeneity and clonal evolution of multiple myeloma

多发性骨髓瘤(MM)是血液系统恶性肿瘤,即使患者在治疗后达到深度缓解,最终仍会复发,这可能与克隆异质性和克隆演变有关。克隆异质性是MM的特征,在骨髓微环境和抗肿瘤治疗的选择压力下,亚克隆遵循不同的进化模式发生演变,如分支进化模式、线性进化模式、中性进化模式等,克隆演变贯穿于MM各个阶段,推动着MM的发生、耐药及复发。该文对MM克隆异质性、克隆演变及临床意义进行综述,以期为临床治疗决策提供新思路。

Multiple myeloma(MM)is a malignant tumor of the hematological system.Even if the patient reaches deep remission after treatment,it will eventually relapse,which may be related to clonal heterogeneity and clonal evolution.Clonal heterogeneity is a characteristic of MM.Under the pressure of bone marrow microenvironment and anti-tumor therapy,subclones follow different evolutionary patterns,such as branching evolution,linear evolution,neutral evolution and so on.Clonal evolution runs through all stages of MM,promoting the occurrence,drug resistance and relapse of MM.This article reviews the clonal heterogeneity,clonal evolution and clinical significance of MM,in order to provide new ideas for clinical treatment decision-making.