| [Objects] Multiple Myeloma (MM) is a kind of malignant tumor which have some characters include proliferative plasma cell (myeloma cell) which secrete amount of abnormal monoclone immune globulin (M-protein), normal globulin decreasing and osteolysis or osteoporosis. The etiology of Multiple myeloma is still unknown. Its clinical manifestation is related to the proliferative myeloma cell and M-protein. If myeloma cell infiltrate bone marrow, osteoporosis will occur that leads to pathologic bone broken; Myeloma cell will inhibit hematopoiesis that leads to anemia and thrombocytopenia; M-protein will inhibit the normal function of immune globulin, which will lead to immune defection and infection. M-protein is excreted by kidney that will be absorbed by renal tubule and be toxicity to renal tubular epithelial cell; It also occludes thetubular cavity and leads to renal failure. M-protein interrupt blood coagulate factors activity; interfere fibrinogen polymerization; block platelet function; leads to bleeding in the end. A great deal of M-protein induce hyperviscosity, increase resistance of circulation and embolism in small vessels, leads to ablepsia, hearing loss and neurological symptoms.Plasmapheresis separate and remove pathosis globulin from patient's blood by special equipment. Now it have extensively been used in many auto-immune disease such as systemic lupus erythematosus, Henoch-Schonlein purpura and Guillain-barre syndrome successfully. But there are little reports about the treatment of MM. In this study, we will assess the clinical value of plasmapheresis in multiple myeloma.[Method] Thirteen patients, diagnosed as MM in Sir Run Run Shaw hospital from 1994 to 2005, were reviewed and analyzed. Total plasmapheresis is 27 sessions, including plasma exchange 22 sessions (membrane separation 13 and centrifugalization separation 9) and Double plasmapheresis 5 sessions. Blood flow is 100-180ml/min; exchanged plasma volume is calculated as followed formula: body weight(kg)× 70ml/kg×(1-HCT). We compared the patients' hemoglobin,renal function, blood viscosity before and after plasmaphresis. We also detect patients' urine protein, renal function and immune globulin after one year to assess the long term effect of plasmapheresis, if the patients were followed up for more than one year. The software SPSS was employed for statistical analysis.[Result] We compared the data before and after plasmapheresis. The patients' hemoglobin elevated from 7.6±2.9 g/L to 8.4±2.2g/L (P<0.05). The creatinine clearance elevated from 41.6±19.1 ml/min to 55.5±21.2 ml/min (P<0.05). Plasma globulin decreased from 78.4±32.6g/dl to37.5±15.6 g/dl(P<0.01). Some data of hyperviscosity had changed, that were benefit to the patients. ESR decreased from 116±38mm/h to 96±29mm/h (P<0.01). Plasma viscosity dropped from 1.7±0.4 to 1.2±0.3 (P<0.05). The symptoms of MM improved.One year later 83.3% patients with urine protein become negative. 75% of patients with renal function damage improved and got stable for long time. 84.6% of patients' plasma globulin got better than that before therapy.[Conclusion] Plasmapheresis can remove a great deal of M-protein and equilibrium the ratio of plasma protein effectively and immediately. In patients with renal damage, plasmapheresis can improve it whether in the near future or long term. Plasmapheresis can improve some complication such as anemia, hyperviscosity and hyperglobulinemia, which make it impossible for the patients be tolerant to the next step——chemotherapy.
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