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Biochemical markers of bone metabolism in multiple myeloma.
Cancer Treatment Reviews ( IF 11.8 ) Pub Date : 2006-05-09 , DOI: 10.1016/s0305-7372(06)80004-6
Evangelos Terpos 1
Affiliation  

Osteolytic bone disease is a major clinical feature of multiple myeloma (MM). Mechanisms of bone destruction are related to increased osteoclastic activity, which is not accompanied by a comparable increase in bone formation, as osteoblasts are functionally exhausted. Thus the lesions rarely heal and bone scans are often negative in myeloma patients with extensive lytic lesions, offering very little in the follow-up of bone disease. Biochemical markers of bone resorption, such as N- and C-terminal cross-linking telopeptide of type I collagen (NTX, CTX/ICTP, respectively), tartrate resistant acid phosphatase isoform-5b, bone formation (bone-specific alkaline phosphatase [BAP]), and osteocalcin provide useful information on bone dynamics. Several studies have shown that NTX, CTX, and ICTP are elevated in myeloma patients, reflect the extent of bone disease, and correlate with survival. Furthermore, they are useful in monitoring bone destruction during antimyeloma or bisphosphonate treatment. Markers of bone formation have produced conflicting results in trials. However, BAP correlates with bone pain, lytic lesions, and fractures in quite a few studies of MM. Novel markers, such as bone sialoprotein, receptor activator of nuclear factor-kappa B ligand (RANKL), osteoprotegerin, osteopontin, dickkopf-1, and soluble Frizzle-related protein-2 have been found of value in assessing bone lytic disease in MM, but their promising results must be confirmed in large trials. In conclusion, although no marker provides optimal analysis of MM or of MM treatments, combinations of markers have at times helped in assessing MM stages and lytic bone disease and in monitoring specific treatment modalities. The need for further research in this field is clear.

中文翻译:

多发性骨髓瘤骨代谢的生化标志物。

溶骨性疾病是多发性骨髓瘤(MM)的主要临床特征。骨破坏的机制与破骨细胞活性的增加有关,而破骨细胞的活性却没有相应的增加,因为成骨细胞的功能已经耗尽。因此,病变很少愈合,并且在具有广泛溶解性病变的骨髓瘤患者中,骨骼扫描通常是阴性的,在骨骼疾病的随访中几乎没有。骨吸收的生化标志物,例如I型胶原蛋白的N和C末端交联端肽(分别为NTX,CTX / ICTP),抗酒石酸酸性磷酸酶同工型5b,骨形成(骨特异性碱性磷酸酶[BAP] ]),骨钙蛋白提供了有关骨骼动力学的有用信息。多项研究表明,骨髓瘤患者中NTX,CTX和ICTP升高,反映骨骼疾病的程度,并与生存相关。此外,它们可用于监测抗骨髓瘤或双膦酸盐治疗期间的骨破坏。在试验中,骨形成的标记产生了矛盾的结果。但是,在许多MM研究中,BAP与骨痛,溶解性病变和骨折有关。发现了新的标记物,例如骨唾液蛋白,核因子-κB配体的受体激活剂,骨保护蛋白,骨桥蛋白,dickkopf-1和可溶性毛躁相关蛋白-2,对评估MM的骨溶解性疾病具有重要价值,但其有希望的结果必须在大型试验中得到证实。总之,尽管没有标记物可以提供对MM或MM治疗的最佳分析,标记物的组合有时有助于评估MM阶段和溶骨性疾病以及监测特定的治疗方式。显然,在这一领域需要进一步研究。
更新日期:2019-11-01
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