多发性骨髓瘤诊断标准的变迁及其对治疗的影响

The changes in the multiple myeloma diagnostic criteria and its impact on treatment

  • 摘要: 多发性骨髓瘤在很多国家是发病率排列第二位的血液系统恶性肿瘤,随着治疗手段的多样化,对其生物学特性的不断深入了解,多发性骨髓瘤的诊断标准也在不断发生改变。从1975年的强调数值,到2011年的强调症状,再到2013年的再次强调数值,疾病诊断手段的不断增多引起中国多发性骨髓瘤诊断标准不断变化,包括流式细胞术对骨髓浆细胞单克隆属性的鉴定,免疫固定电泳以及血清游离轻链对免疫球蛋白单克隆属性的判定等。伴随诊断标准的改变,治疗人群也在发生改变。在1975年的国内诊断标准中,约20%的患者得不到及时诊断,而在未来的诊断标准中会有一部分无症状型多发性骨髓瘤患者被提前诊断而进入治疗目标人群。

     

    Abstract: Multiple myeloma(MM) was the second malignant hematological disease in many countries. There had continuing change in diagnostic criteria in MM, along with the more treatment methods and the understand of this disease. From 1975 to 2013, the change of diagnostic criteria experienced three stages. Firstly, we emphasized the numerical value in 1975, secondly, we emphasized the clonal characteristics of plasma cell and wakened the numerical value because of the FACS and immunofixation widespreadly used, thirdly, we emphasized the number again because of the differentiation of primary amyloidosis. Along with these changes, the target population had changed also, 20% patients cannot be diagonsed if using criteria of 1975, and some asymptomatic MM may be diagnosed with MM in the future.

     

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