11例多发性骨髓瘤合并自身免疫性溶血性贫血患者的临床特征分析

Clinical features of multiple myeloma complicated with autoimmune hemolytic anemia: series of 11 cases

  • 摘要: 目的 分析多发性骨髓瘤(multiple myeloma,MM)合并自身免疫性溶血性贫血(autoimmune hemolytic anemia,AIHA)患者的临床特征,以提高对该病的认识。 方法 回顾性分析我院2013 - 2018年收治的多发性骨髓瘤合并自身免疫性溶血性贫血病例11例,分析其临床特征、实验室检查结果、治疗及转归。 结果 11例多发性骨髓瘤患者中男4例,女7例,中位年龄60.73(41~77)岁,分别以骨痛、头晕、乏力等不同临床表现起病,5例自身免疫性溶血性贫血发生于多发性骨髓瘤初诊时,6例发生于多发性骨髓瘤化疗过程中。10例发生自身免疫性溶血性贫血时均伴有不同程度的感染,以肺部感染为主;11例溶血发作时Coombs实验阳性率为100%,且均为温抗体型;11例中,9例多发性骨髓瘤为IgG型,2例为IgA型。11例多发性骨髓瘤分期均为中晚期,10例接受了相应的化疗方案,其中9例含有沙利度胺。11例中9例死亡,1例失访,1例存活,中位生存期7(1~28)个月,随访结束时Coombs实验转阴率为27.2%(3/11)。 结论 多发性骨髓瘤合并自身免疫性溶血性贫血临床少见,患者因严重感染、溶血,总体预后差,死亡率高。

     

    Abstract: Objective To investigate the clinical features of multiple myeloma (MM) combined with autoimmune hemolytic anemia(AIHA), so as to raise the awareness of this disease. Methods We retrospectively analyzed 11 cases of multiple myeloma with autoimmune hemolytic anemia admitted to our hospital from 2013 to 2018, including their clinical features, laboratory findings, treatment and outcomes. Results Of the 11 patients with multiple myeloma, there were 4 males and 7 females with median age of 61 (41-77) years old, all patients presented with different clinical symptomsincluding bone pain, dizziness and fatigue. Autoimmune hemolytic anemia occurred during the initial diagnosis of multiple myeloma in 5 cases, and it occurred during the chemotherapy of multiple myeloma in 6 cases. Ten cases had different degrees of infection, mainly presented with pulmonary infection. The positive rate of Coombs test was 100% in 11 cases, and all of them were warm type. Among the 11 cases, 9 cases were IgG type and 2 were IgA type. Of the 11 cases in intermediate or late stage, 10 cases received chemotherapy regimens, among which 9 took thalidomide.Nine cases died, 1 case lost to follow-up and 1 case survived. The median survival was 7 (1-28) months, and the conversion rate of Coombs test was 27.2% (3/11) at the end of the follow-up. Conclusion Multiple myeloma combined with autoimmune hemolytic anemia is rare in clinical practice. Due to severe infection and hemolysis, the overall prognosis is poor and the mortality rate is high.

     

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