髓外多发性骨髓瘤的治疗进展

Treatment progress in extramedullary multiple myeloma

多发性骨髓瘤(Multiple myeloma, MM)是一种浆细胞异常克隆性增殖导致的恶性肿瘤,髓外多发性骨髓瘤(Extramedullary multiple myeloma, EMM)为MM细胞恶性增殖后产生侵蚀骨表面或骨外部组织的实体瘤。有70%的MM患者尸检时发现伴有髓外肿块,表明EMM的发生率高。现有的治疗手段虽使MM的疗效得到巨大改善,但EMM的预后仍较差。本文就EMM的治疗现状进行综述,主要从蛋白酶体抑制剂(Proteasome inhibitors, PI)联合免疫调节剂治疗(Immunomodulatory drugs, IMiD)、嵌合抗原受体T细胞(Chimeric antigen receptor T-cell, CAR-T)免疫治疗、自体干细胞移植(Autologous stem cell transplantation, ASCT)、核输出蛋白抑制剂及单克隆抗体苯达莫司汀治疗6个方面进行介绍,以期为临床医生选择治疗方案提供参考。

Objective Multiple myeloma(MM)is a malignant tumor caused by abnormal clonal proliferation of plasma cells.The extramedullary multiple myeloma(EMM)is a malignant proliferation of MM cells,resulting in a solid tumor that erodes the surface or external tissue of bone.Extramedullary masses are found at autopsy in 70%of MM patients,indicating that the incidence of EMM is high.Although the therapeutic effect of MM has been greatly improved by the existing treatment methods,the prognosis of EMM is still poor.This article reviews the current treatment for EMM,focusing on proteasome inhibitors(PI)combined with immunomodulatory drugs(IMiD),chimeric antigen receptor antigen receptor T-cell(CAR-T)immunotherapy,autologous stem cell transplantation(ASCT),exportin inhibitors,monoclonal antibody and bendamustine,and aims to provide references for clinical doctors to choose treatment plan.