多发性骨髓瘤髓外病变发病机制的研究进展

Research progress in the pathogenesis of extramedullary disease in multiple myeloma

多发性骨髓瘤(MM)病灶多局限于骨髓内,初诊或诊治过程中可出现远离骨髓或临近软组织的恶性浆细胞浸润即多发性骨髓瘤髓外病变(MM-EMD)。MM-EMD具有高度侵袭性,其临床行为不同于骨髓限制性骨髓瘤,该类患者预后差。但其发病机制尚未阐明,目前研究认为,MM细胞归巢受阻、侵袭力增强、细胞外基质降解及血管生成能力增强等过程可能参与MM-EMD发生。肿瘤遗传学异常和骨髓微环境改变等在上述发病过程中发挥重要作用。

Multiple myeloma(MM)lesions are mostly localized in the marrow.Extramedullary disease in multiple myeloma(MM-EMD)is defined as malignant plasma cell infiltration away from the bone marrow or adjacent soft tissue,may occur at the initial diagnosis or during the consultation.MM-EMD may be found at initial diagnosis or during the treatment.MM-EMD has high invasiveness and poor prognosis,with clinical behavior distinct from marrow-restricted myeloma.However,its pathogenesis has not been elucidated.In general,the obstructed homing of myeloma cells,enhanced invasiveness,the degradation of extracellular matrix,and increased angiogenesis capacity may be involved in the occurrence of MM-EMD.Tumor genetic abnormalities and changes in the bone marrow microenvironment play important roles in the above pathogenesis.