Achieving Complete Response in Multiple Myeloma: Do We Need to Change the Definition?

多發性骨髓瘤的完全緩解：我們需要改變定義嗎？

楊文祺(Wen-Chi Yang) ； 林勝豐(Sheng-Fung Lin)

《內科學誌》 22卷4期 (2011/08) Pp. 266-277

https://doi.org/10.6314/JIMT.2011.22(4).05

摘要

多發性骨髓瘤是漿細胞（一種B細胞）不正常增生的腫瘤，其發生率在不同的國家從十萬分之一到十萬分之四不等，這可能是因爲在有些國家中的診斷率太低；多發性骨髓瘤目前的治療目標是放在延長疾病惡化的時間及整體存活率，近幾年，因診斷及偵測方法的進步，如用即時定量PCR檢測免疫球蛋白重鏈的重新排列、多分項的流體細胞移檢測表面抗原、基因微陣列晶片偵測甲基化、以及影像診斷如正子攝影，我們可以偵測較微量的殘存腫瘤細胞，有些近年來的研究顯示疾病在治療後達到分子檢查的緩解與疾病惡化時間與存活率有正向相關性。EBMT (European Group for Blood and Marrow Transplant)及IMWG (International Myeloma Working Group) uniform criteria是目前評估多發性骨髓瘤治療反應的標準，但似乎對整體預後的預測不夠敏感。日後以更精確敏感的方法檢測治療效果，是達到長期良好的反應所必需的，也可使完全緩解的定義更爲精準。

並列摘要

Multiple myeloma is a B cell neoplasm with monoclonal plasma cell expansion. The incidence varies between different countries from one per 100,000 to four per 100,000, probably due to under-diagnosis in developing countries. The therapeutic goal for multiple myeloma is prolonged progression free survival and overall survival. In recent years, it has been possible to detect smaller amounts of residual tumors through diagnostic and monitoring tools, such as IgH rearrangement qRT-PCR, multiparameter flow cytometry, microarray studies for methylation and imaging studies (e.g., positron emission tomography). A few studies have also proved the correlation between achieving molecular remission after treatment and progression free and overall survival. Therefore, the European Group for Blood and Marrow Transplant (EBMT) and International Myeloma Working Group (IMWG) uniform criteria seem to be inadequate to evaluate treatment response. Further studies on more sensitive tools are necessary for more accurate disease status evaluation.

並列關鍵字

Multiple myeloma ； Minimal residual disease ； Multiparameter flowcytometry ； Real time RT-PCR