International Myeloma Foundation
Patient Handbook
Multiple Myeloma
Cancer of the Bone Marrow
Korean Language Edition
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13,500
20% 1% .
1/100,000 4/100,000
. .
3 2 , ,
.,
55 . ,
, , , ,
.
?
(plasma cell).
.
( : myeloma cell)
.
. ( )
. (:)
,
.
.
.
(multiple) "myelo"
" omas" .
.,
DNA
.
.
5%
.
,30% 90%
,
.
(
.) .
.
, .
,
. ,, , .
.
.
.
. IL-1,IL-6,TNF
(cytokine) , (osteoclast)
. 30%
X .
(osteoporosis)
(lytic lesion) .
(pathological fracture) .
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, .
, , .
, .
.
.
. ,
.
. , / ,
()
.
.
( :hypercalcemia) , , ,
.
.
.
? ?
/
.
.
.
(:biopsy)
.
.
(bone marrow)
10% 30% .
:(=kappa) (=lambda)
L- (light chain)/
.
( direct biopsy)
. 90~100%
,
.
(Supportive findings)
30%
.
I/ (M-
)( :staging test ).
IIX .
(lytic lesions) .
(MRI), MIBI FDG/PET
.
. (MGUS)
(smoldering myeloma) .
.
. (monoclonal protein)
(auto-immone disease)(: :systemic lupus
erythematosis , :scleroderma) (: :multiple
sclerosis, : amyotrophic lateral sclerosis[ALS])
. .
(Solitary plasmacytoma).
.
. ( )
. ,
.
. ,
. ,
.
(Monoclonal Gammopathy of Undetermined
Significance : MGUS).
(10% 20% ),
.( 0% ). ,
, . MGUS
, . 2
.
, 10 30% .
MGUS
.
(Indolent myeloma).
MGUS . ,
.
.
(Smoldering myeoloma).
MGUS . .
(STAGING AND PROGNOSTIC FACTORS)
.
1. ?
Durie-Salmon (Staging
System) . ,
.
Stage I
( ) Stage III()
A( )
B( ) . :
Stage I A- , .
Stage III B- , .
Stage III , Stage III B
. .
2. ?
,
. .
,
(labeling
index)
.serum
-2
microglobulin ,
(Bone marrow chromosome test)
. 11 ,13 ,14 ,
. 5 7
,
(myelodyplastic
syndrome:MDS) (stem cell) .
, ,
(amyloid deposits) .
H-(heavy chain) L-( light chain)
.
:
IgG: k lambda
IgG: k lambda
k lambda .( :Bence Jonces myeloma)
:
IgD: k lambda
IgM: k lambda
IgE: k lambda
. , lambda
, IgG kappa
, .
?
. .
1.
(STABILIZING)-
.
: .
: (plasmapheresis): .
(hemodialysis): .
(: pamidronate): ,
2.
(PALLIATIVE)-
.
:
: : .
(Erythropoietin): .
: .
3.
(REMISSION-INDUCING) ,
.
:
: : .
: .
4. (CURATIVE) , . (
.)
:
: .
.
, .
.
, .
?
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(CHEMOTHERAPY)
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(RADIATION THERAPY)
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(BONE MARROW TRANSRANT: BMT AND PRERIPHERAL BLOOD
STEM CELL TRANSPLANT: PBSCT)
. ,
.
,
.
. ,
, .
. , (administering treatment)
.
,
.
.
( : allogenic transplant) ( :
autologous
transplant)
.
,
.
(:VAD) .
. . ""
,
.
(
)
(
)
, ,
.
.
,
.
D. (MAINTENANCE THERAPY)
,
.
.
. :
(I)
(Interferon alpha):
.
. , .
,
3 .
(II)
( Steroids ) ( : prednisone
prednisolone): .
3
. ,
.
(III)
( Supportive care measures):
. (bisphos-
phonate)(: clodronate, pamidronate)
,
.
(Erythropoietin)
(hemoglobin)
.
(IV)
(New approaches):
.
prolotol testing
.
(Thalidomide)
,(angioge-
nesis agents) .
.
, () ,
.
( I ): .
/ /
. (local anaesthetic )
.
.
.
(II ) : .
(III) :
.(:)
(IV) : (Bisphosphonates)
.
(V) :
.
. ,
(:ibuprofen) ,
.
?
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/ .
(Alkylating Agent):melphalan cyclophosphamide
. DNA
.
(Amyloidosis): L-(light chain)(- )
.
- ,
,L-
,, .
(Anemia): .
10G%,13-14G% .
,, .
(Antibody):
.
(Appendicular Skeletal):, ,,
.
(Axial Skeletal):, , .
-(Bence Jence): .
(Beta 2 Microglobulin):
. , .
/ ,
.
10% ,
. ,
. ,
90%
.
(Bisphosphonate): ()
.
(Bone Marrow):
.
(Bone Marrow Aspiration):
.
(Bone Marrow Biopsy):
.
(Bone Marrow Remodeling):
, ,
.
(Calcium): (Matrix) (Hydroxyapatite)
.
(Calcitonin):
.
(Calcitrol): D D
CAT (Computetized Axial Tomography):
.
(Chmotherapy): .
(Clinical Trials): .
(Consolidation Therapy):
.
.
(Coupling):
.
(Creatinine): .
,
.
.
( Cytokine): .
,
.
DEXA(Dual Photon X-ray Absorptionmetry):
X . .
Dexamethasone: .
(dialysis):
.
()(Electrophoresis):
.
.
M-spike .
.
(Erythropoietin): .
,
.
.
.
,
(Hypercalcemia): .
, .
, ,
IV (IV fruid)
,
.
IgG,IgA: .
G A .
(immunoglobulin) H-(heavy
chains)(G
),(lambda)
(kappa)
L-(light
chains) ., H-(:IgG kappa
IgG lambda) . L-
L-(-) .
H(heavy) L(light) ,
H- L- . L-
- .
IgD.IgE: IgG ,IgA .
(Immunofixation): M-(IgG ,IgA lambda
kappa) .
(immunostaining technique). M- H- L-
.
(Induction Therapy):
.
(Interferon):
(cytokine) .
,
.
(Interferon-6):
.
(Lytic Lesion): X
,
.
, .
(Monoclonal) : ()
. ,
(polyclon) . (M-spike)
M-: .
L- . 24
G . 0.1G/24hrs
, (albumin)
.
.
, M-spike, .
MRI (Magnetic Resonance Imaging):X- ,
.
, ,
.
M-spike: M- . Spike M-
(Electrophoresis)
.
(MDR): ,
adriamycin vincristin .
p-glyco ,
, ,
. p-glyco
. (: PSC833
:cyclopsporin analogue)
(Nephelometry):
.( ). ,
.
(Neutropenia): (neutrophils) .
,
(granulocyte)(neutrophils) , Cytoxic
. , , ,
Cytoxic .
(Osteoclast): .
.
,
. , ,
, ,
(Lytic Lesion) .
(Osteoporosis): .
X
.
(Pathological Fractures):
.
(Plasma Cell): .
. ,
,
M- .
. (:
, ,)
(Plasmacytoma): , ,
.
(plasmapheresis):
(Platelet): .
.
, .
Progression-Free Survival:
.
.
(Osteoblast) : .
.
(Osteoid): .
.
(Radiation Therapy):
.
(Red Cells):
. ,
. (Erythropoietin)
. ,
,
.
. , .
,
.
(Response or Remission):
.
(Complete Remission:CR):
.
CS .
,
.
.
. ,
,
.
(Partial Remission:PR):PR CR
.SWOG , 50%~75% ,
50%.
(Stable Disease):
50% .
CR PR ,
.
, , .
/(Skeletal Survey/Metastatic Survey):
,,,,
.
(Serun Osteocalcin):
. .
.
;(Stem cell): ,,
. ,
.
(Thrombocytopenia): .
150, 000-250,000 , , 50.00
. , 10.000 .
(Transplantation):
/ .
,
.
(Allogenic): HLA
. HLA (Histocompata-
bility Locus Antigens) .
(Unrelated Allogenic Transplant) .
(Autologous):
. .
(PBSC):
.
(syngenic): .
(White Cells): .
.(::neutrophils, :
lymphocytes,: monocytes)
, , (neutropenia)
, . G-CSF(:Neupogen)
.
(Amyloidosis): . , congo
red
: , , (Chemistry
panal test)LDH, ,Serum bete 2 microglobulin ,
CRP,
: .
:X , MRI / CT
, MIBI / PET .
: 24 , (Bence-Jones)
(creatinine clearance) .
INTERNATIONAL MYELOMA
FOUNDATION
..
UNITED STATES OF AMERICA
12650 Riverside Drive, Suite 206
North Hollywood, CA 91607-3421
U.S.A.
(800)452-CURE
(818)487-7454Fax
E-mail: TheIMF@myeloma.org
UNITED KINGDOM
9 Gayfield Square
Edinburgh EHI-3NT
U.K
0131-557-3332
0131-556-9720Fax
E-mail:TheIMF@myeloma.org.uk
Website:www.myeloma.org.uk
©2001 International Myeloma Foundation.
Document Outline