경희대학교 의과대학·의학전문대학원

전체 글

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형질세포 질환

경희의대 내과 윤휘중

혈액학 통합강의

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Multiple Myeloma

• malignant proliferation of plasma cells

• tumor, its product, host response -->

bone pain or fracture, renal failure,

susceptibility to infection, anemia,

hypercalcemia, clotting abnormality,

neurologic symptoms, hyperviscosity

syndrome

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 Medical Emergency:

cord compression, pathologic

fracture, hyperviscosity, sepsis,

hypercalcemia

POEMS syndrome

1. Polyneuropathy

2. Organomegaly

3. Endocrinopathy

4. Monoclonal gammopathy

5. skin change

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Ig D 골수종

1) 발생연령이 낮다 . 2) 남성이 많다 . 3) extramedullary disease 가 많다 . 4) organomegaly 가 많다 . 5) total protein 의 양이 낮다 . 6) M-protein 의 peak 가 낮거나 없다 . 7) lambda 형 우위를 보인다 .

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Prognostic Factors in Multiple

Myeloma

• Patient factors:

A

ge

P.S.

Concomitant

illness

• Clinical Stage

• 2M

• IL-6, LDH, TK

• Morphological

factors:

plasmoblastic subtypes

plasma cell %

circulating plasma cell

• Cytogenetics, 13q del

• CRP, etc.

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Event-free and overall survival times based on serum LDH levels at diagnosis and 13 in a group of 155 newly diagnosed myeloma

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Event-free and overall survival times of 515 patients receiving autotransplants and a median follow-up of at least 5 years.

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(1) M 단 백 : immunoelectrophoresis 또 는 immunofixation, electrophoresis

a) 혈청 : H 또는 L-chain 검사 , M 단백 정량 b) 소변 : 단백배설량 , M 단백 정량

(2) 골수검사 : 형질세포의 percentage, labeling index (3) 골격계 X- 선 조영술 : 골연화증 , 척추 압박골절 , 고립성

골수종 , 골용해 병소

(4) 생 화 학 적 검 사 : calcium, creatinine, 2-microglobulin

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