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香港,中国 - Media OutReach - 2019412 - 多发性骨髓瘤属于血癌的一种,又称为浆细胞骨髓瘤。其成因是骨髓内负责制造抗体的浆细胞异常增生,细胞由良性变为恶性。在香港,浆细胞骨髓瘤每年大概有超过200个新发病例,发病年龄通常为70岁或以上。此病会使血小板、红细胞及白细胞减少,导致贫血。另外,由于癌细胞侵蚀骨骼,会引起骨痛或骨折。如老年人突然出现骨痛和贫血,验血后发现球蛋白含量升高,便有可能是患有骨髓瘤,应进行骨髓检查,以检测异常浆细胞。

 

浆细胞骨髓瘤的进展缓慢,可潜伏在体内十至二十年才发病,因此癌细胞有足够时间经血液入侵全身的骨髓,难以根治。治疗虽然无法彻底消灭癌细胞,但通常能控制病情,不过癌细胞有机会再次变得活跃,导致癌症复发。相比首次发病,复发一般较难治疗。对于年纪较大的患者,治疗目标是降低复发机会,除了延长生存期,同时也需要维持病人的生活质量。

 

以往治疗浆细胞骨髓瘤只有化疗和类固醇两类药物,一般只能控制三年病情,即使65岁或以下的患者能够进行自体骨髓移植,提升化疗的成效,但也都只能平均额外延长多一年寿命。近年新一代的靶向药,包括免疫调节剂和蛋白酶抑制剂,不仅能针对性地治疗骨髓瘤,而且副作用也比化疗和类固醇少很多,可控制病情长达七年或以上。当旧有蛋白酶抑制剂出现抗药性,再转用新一代蛋白酶抑制剂(如卡非佐米)时,其药效相对较强,而且起效速度较快,并能延长病人的缓解期,因此可望取代旧有药物作为一线的治疗选择,无需等抗药性发生时才使用。 

 

医生会视乎病人的症状和病情,选择最合适的治疗组合。如病人使用双靶向药,并配以化疗和类固醇,便不一定需要骨髓移植。一旦病情受控,病人便可转用低剂量的靶向药,并长期接受治疗以预防复发。

 

血液及血液肿瘤专科區永仁醫生

 

资料来源:

健康研究所

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