移植后的双重恶性病:多发性髓瘤和乳头性细胞癌-A病例报告
Aleksandar Petrov1, Miroslava Benkova1, Yavor Petrov2
1Clinic of Nephrology, University Hospital "St. Marina" EAD, 1 Hristo Smirnenski Blvd., 9010 Varna, Bulgaria.
Reports (MDPI)
|January 21, 2026
概括
移植脏的患者面临更高的癌症风险. 这一案例突显了多发性骨髓瘤和原生癌的罕见连续发生,强调了仔细监测和为保护移植物量身定制的治疗.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 在瘤学瘤学.
- 移植医学 移植医学 移植医学
背景情况:
- 与普通人群相比,移植接受者 (KTRs) 的癌症风险增加了2-4倍.
- 多发性骨髓瘤 (MM) 和本源脏细胞癌 (RCC) 的同时或连续发展在KTRs中不常见.
- 这种双重恶性瘤带来了复杂的治疗挑战,平衡了抗髓瘤疗法与对全移植保存的关键需求.
研究的目的:
- 报告一例罕见的顺序性多发性骨髓瘤和本源脏细胞癌在脏移植接受者的病例.
- 讨论这种复杂病例的管理策略和临床结果.
- 强调警的癌症监测和定制的免疫抑制在KTRs的重要性.
主要方法:
- 一个54岁的女性脏移植接受者的案例研究,她发展了MM和本地脏RCC.
- 治疗涉及一线博尔特佐米布/cyclophosphamide/dexamethasone (VCd) 与塔克罗利斯和低剂量类固醇,其次是二线达拉图穆马布/carfilzomib/dexamethasone (DKd) 治疗复发性MM.
- 治疗包括成像,实验室检查,化疗,腎切除术和息性放射治疗.
主要成果:
- 患者在一线VCd治疗中获得了非常好的部分反应,并具有稳定的移植功能.
- 卷状RCC,II型,在原生右中被诊断出来.
- 复发的MM与脊髓压缩需要二线DKd和放射治疗,由感染和泛细胞衰竭复杂化,导致预后和患者死亡.
结论:
- 移植后的癌症监测,包括本地脏查,对于早期检测至关重要.
- 量身定制的免疫抑制和多学科护理对于管理多种恶性瘤的KTRs至关重要.
- 虽然VCd与tacrolimus可能是可行的植入物保存,在DKd上先进的MM带来了显著的感染风险和不良预后.
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