Transcription of 多発性骨髄腫(multiple myeloma : MM) 多発性骨髄腫(MM)は免疫グロブリンを産生する形質細胞の ...
1 -1 - (multiple myeloma : MM) (MM) 60 M M M-bow L Bence Jones BJP X punched-out lesion 10 M 2 3 10 3 5 1 (MM) -2 - 2 1 6 1 -3 - 3 (M ) 2 3 MGUS -4 - 4 5 1 1 40 60 70 1 1 -5 - 1992 60 1850 Macintyre Bence Jones Bence Jones 1 1873 multiple myeloma 2 B 1.
2 In vitro VLA-4 5 CD40 40L CD28 CD80 86 2. IL-6 IL-1 LIF OSM GM-CSF G-CSF IL-6 IL-6mRNA 3. C-myc Bcl-1 2 N-ras K-ras IgH 4 B -6 - 5 3 Kyle M M 19 20 M MGUS ; monoclonal gammopathy of undetermined significance MGUS241 (1) (2)M IgG IgA IgD IgE BJP type (3) mature inter-mediate immature plasmablastic 6 CRABO 2013 -7 - 6 MGUS 7 -8 - 8 7 MGUS -9 - 2013 -10 - 8 IMWG 2013 -11 - 9 IMWG uiform response criteria -12 - 2013 2013 -13 - 2013 10 2013 11 11 (MDS )
3 + (M ) (M ) M , (M ) Ca , ,M , Ca , MIP- CEA Ca 30% 20% 15% 10% 4% ( ) -14 - 9 12 -15 - 13 2 1 60 65 70 75 10 M M M-bow Bence Jones Bence Jones Bence Jones X CT MRI Ca 2 1.
4 X CT MRI OAF osteoclast activating factor OAF TNF IL-1 IL-6 G-CSF -16 - 2. Bence Jones Ca IgD Bence Jones 3. 50 3 Durie & Salmon M M Ca 5 10 Durie-Salmon -17 - 11 Durie-Salmon ( ) 12 Durie-Salmon ( ) 4 -18 - 13 (ISS) 14 ISS -19 - 14 ISS( ) 15 ISS( ) -20 - 16 ISS( ) 17 !
5 SS ( ) -21 - 18 ( ) 1 4 3 10 3 5 1 PS performance status H b LDH Ca 2 CRP BJP UA labelling-index 3 19 ( ) -22 - 20 21 ( ) -23 - 22 23 -24 - 15 16 -25 - 17 ( ) 24 5 ( ) -26 - 25 ( ) 26 ( ) -27 - 27 ( ) 18 -28 - 28 ( ) 29 ( ) -29 - 30 ( ) 31 -30 - 32 33 -31 - 34 35 -32 - 36 37 -33 - 38 39 -34 - 1 1.
6 2. 3. 4. 1)MP 1998 2).CP CVP MCNU-VMP CP CVP MCNU-VMP MCNU 3)VAD 4) M-2 VMCP VCAP VBAP hyper CVAD high-dose melphalan 5)IFN- IFN- MP I II 2 3 laminectomy 4 1. Ca 2. 3. - G-CSF -35 - 40 19 -36 - 20 -37 - 41 21 -38 - 42 t(11;14) cyclinD1(BCL1)-IgH 43 t(4;14) FGFR3-IgH -39 - 44 del( ) 45 -40 - 46 2013 -41 - 47 2013 22 -42 - 25 5 1.
7 2. 3. MMF ATG DLI 48 -43 - 6 1998 TNF VEGF 7 1. IL-6 IL-6 IL-6 autocrine 2. CD38 CD38 ricin 3. Idiotype Id - GM-CSF Id 23 -44 - 24 25 -45 - 49 50 -46 - 51 52 -47 - 53 26 2013 -48 - 27 3 54 -49 - 55 -50 - 56 -51 - 28 57 -52 - 58 Elotuzumab -53 - 59 DKK1 -54 - 60 61 -55 - 62 63 -56 - 64 65 -57 - 66 67 PET-CT -58 - 68 69
8 -59 - 2013 -60 - 70 2013 -61 - 29 2013 -62 - 71 ( ) 72 AL 2013 -63 - 2013 73 AL 2013 -64 - 2013 2013 -65 - 2013 -66.
