Update of diagnosis and treatment of multiple myeloma from the 19th European Hematology Association Annual Congress / 白血病·淋巴瘤

ABSTRACT

Pathophysiology of myeloma bone disease is unclear and complex.At early stage,osteoclastic bone resorption is increasing,myeloma cells are dependent upon the cells of bone for growth and survival.With the increase in tumor burden,osteoblast suppression is maintained.Based on the diagnosis of multiple myeloma (MM),conventional morphology,M proteins and skeletal survey are effective approach for diagnosis and monitoring of MM.However,the multiparameter flow cytometry (MFC) has advantage in distinguishing clonal from normal plasma cells.If the patient has significant paraprotein relapse in 2 consecutive measurements separated by no more than two months,the experts of International Myeloma Working Group (IMWG) consider that myeloma therpy should be re-started,even if the symptoms or evidences of new end-organ damage has not yet appeared.For newly diagnosed MM patients who are ineligible for autologous stem cell transplantation,the combination of melphalan,prednisone and with either thalidomide (MPT) or bortezomib (VMP) is the standard treatment option,and then given with lenalidomide and low-dose dexamethasone is gradually developing a new standard continuous therapy.For elderly patients,especially over 75 years old,always have a poor clinic outcome.It should be fully aware that frailty is an independent prognostic factor which carries a greater impact on overall survival than the renal function or cytogenetic abnormalities.Therefore,it must be under consideration in developing individualized treatment programs.