摘要目的 分析伴骨髓纤维化(marrow fibrosis, MF)的浆细胞骨髓瘤(plasma cell myeloma with bone marrow fibrosis, PCM)的临床及骨髓病理学特征.方法 回顾分析175例初诊PCM患者的临床及病理学资料,所有患者均行骨髓活检、网状纤维染色、流式细胞学及荧光原位杂交检测,根据网状纤维染色结果,将其分为PCM-MF组和非PCM-MF组.结果 175例PCM患者中,PCM-MF组 63例(36%),非PCM-MF组 112例(64%).PCM-MF组与非PCM-MF组比较,患者性别、年龄、血红蛋白水平、血小板计数、免疫球蛋白类型、国际分期系统分期、免疫表型及遗传学的差异均无统计学意义(P>0.05).PCM-MF组乳酸脱氢酶升高及肾功能异常发生率均明显高于非PCM-MF组(均P<0.05).PCM-MF组骨髓增生程度、浆细胞比例以及浆母细胞型比例均明显高于非PCM-MF组(均P<0.05).结论 PCM-MF患者具有较高的乳酸脱氢酶水平及肾功能异常的发生率,较高的骨髓增生程度和浆细胞比例,多见浆母细胞样形态,提示其可能为预后不良的类型.

abstractsObjective To study the clinicopathologic features of plasma cell myeloma(PCM) with bone marrow fibrosis (MF).Methods The clinicopathologic data of 175 cases of newly diagnosed PCM patients were retrospectively analyzed. Based on reticular fiber staining, these cases were divided into PCM-MF and non-PCM-MF groups.Results Sixty-three cases were PCM-MF(36%), 112 were non-PCM-MF (64%). No statistical difference in gender, age, hemoglobin level, platelet counts, the classification of immunoglobulin, ISS staging, immunohistochemical phenotypes and genetic features was found between PCM-MF and non-PCM-MF groups (P>0.05). Compared to non-PCM-MF group, lactate dehydrogenase (LDH)level and renal impairmentrate were higher in PCM-MF group (P<0.05). The degree of bone marrow hyperplasia, the percentage of myeloma cells and cells with plasmablastic morphology were significantly higher in PCM-MF group(P<0.05).Conclusion The higher LDH level, renal impairment rate, and more significant bone marrow hyperplasia,proliferation of plasma cells and plasmablastic myeloma cells infiltration indicate poor prognosis of PCM-MF patients.