IgD型多发性骨髓瘤1例并文献复习  

IgD multiple myeloma:report of 1 case and review of literature

作　　者：许晗 聂淑敏[1] 黄俊霞[1] 李田兰[1] 高燕[1] 毛春霞[2] 刘珊珊[1] 徐玉洁 周静静 肖晶晶 王梦莹 孟繁军[1] 冯献启[1] Xu Han;Nie Shumin;Huang Junxia;Li Tianlan;Gao Yan;Mao Chunxia;Liu Shanshan;Xu Yujie;Zhou Jingjing;Xiao Jingjing;Wang Mengying;Meng Fanjun;Feng Xianqi(Department of Hematology,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Neurology,the Affiliated Hospital of Qingdao University,Qindao 266000,China)

机构地区：[1]青岛大学附属医院血液科,青岛266000 [2]青岛大学附属医院神经内科,青岛266000

出　　处：《白血病．淋巴瘤》2022年第2期107-110,共4页Journal of Leukemia & Lymphoma

摘　　要：目的探讨IgD型多发性骨髓瘤(MM)的临床特征及应用达雷妥尤单抗为主方案联合治疗的效果及预后。方法回顾性分析青岛大学附属医院2019年12月收治的1例接受达雷妥尤单抗治疗的IgD型MM进展伴髓外浸润患者的临床病理资料,并复习相关文献。结果患者为74岁女性,经骨髓穿刺及免疫固定电泳等检查诊断为IgD型MM,先后给予VD(硼替佐米、地塞米松)、RD(来那度胺、地塞米松)和ID(伊沙佐米、地塞米松)方案治疗。2020年6月患者出现多发皮下结节,评估病情为疾病进展伴多发髓外浸润,给予达雷妥尤单抗+PAD(脂质体多柔比星、硼替佐米、地塞米松)方案治疗,患者皮下结节较前明显缩小伴部分消失,一般情况较前改善。但患者处于恶病质状态,治疗欠规范,病情反复并持续进展,最终死亡。结论IgD型MM发病率低,生存期短,尚无统一治疗方案,尽早应用达雷妥尤单抗联合蛋白酶体抑制剂、免疫调节剂、细胞毒性药物及造血干细胞移植可能会延长患者生存期。Objective To investigate the clinical features of IgD multiple myeloma(MM)and the effect and prognosis of daratumumab-based combination therapy.Methods The clinicopathological data of a IgD MM patient with disease progression and extramedullary infiltration treated with daratumumab in the Affiliated Hospital of Qingdao University in December 2019 were retrospectively analyzed.Results The 74-year-old woman was diagnosed as IgD MM by bone marrow aspiration and immunofixation electrophoresis.The patient was given VD(bortezomib,dexamethasone),RD(lenalidomide,dexamethasone)and ID(ixazomib,dexamethasone)regimens.In June 2020,the patient developed multiple subcutaneous nodules,and she was assessed as progressive disease with extensive extramedullary infiltration.After treated with daratumumab-PAD(liposomal doxorubicin,bortezomib,dexamethasone)regimen,the patient's subcutaneous nodules were significantly reduced and partially disappeared,and the general condition was significantly improved.But the patient was in a cachexia state and finally died of the irregular treatment and disease progression.Conclusions IgD MM has a low incidence and a short survival period,and there is no uniform standard treatment.The early application of daratumumab combined with proteasome inhibitors,immunomodulators,cytotoxic drugs and hematopoietic stem cell transplantation may improve the overall survival of patients.

关 键 词：多发性骨髓瘤 IGD 髓外浸润 达雷妥尤单抗 

分 类 号：R733.3[医药卫生—肿瘤]