Multipl miyelom'da kemik hastalığının değerlendirilmesi
Assessment of bone disease in multiple myeloma
Yazar: ÖZCAN UZUN
Danışman: PROF. DR. MEHMET ALİ ÖZCAN
Dokuz Eylül Üniversitesi / Tıp Fakültesi / İç Hastalıkları Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2016
Konu: Hematoloji = Hematology
Dizin: Kemik hastalıkları = Bone diseases ; Manyetik rezonans görüntüleme = Magnetic resonance imaging ; Multipl miyelom = Multiple myeloma ; Pozitron emisyon tomografi = Positron-emission tomography ; Sağkalım = Survival ; Sağkalım analizi = Survival analysis ; Teşhis = Diagnosis ; Teşhis-görüntüleme = Diagnostic imaging

Özet:
Bu çalışmada 2005-2015 yılları arasında Dokuz Eylül Üniversitesi Tıp Fakültesi Hastanesi Hematoloji Kliniğinde izlenen 195 multipl miyelom tanılı hasta retrospektif olarak incelendi. Hastaların; tedavi yanıtları, kemik bulguları ve bunları tespit etmekte kullanılan radyolojik görüntüleme yöntemleri gözden geçirildi ve literatüre katkı sağlanması amaçlandı.
Hastaların ortanca yaşı 59 olup, 109'u erkek, 86'sı kadındı. Hastalarda ISS evresi ile ortanca sağkalım süreleri arasında istatistiksel olarak anlamlı fark saptandı (p<0.001).
187 hastamızda kemik survey çekildiği görüldü. 56 hastada litik kemik lezyonu saptanmadığı, 80 hastada litik alan tutulumunun <5 alan olduğu, 51 hastada ise litik kemik alanın >5 alandan fazla olduğu saptandı.
Manyetik Rezonans (MR) görüntülemenin 73 hastada kullanıldığı görüldü. 10 hastada tutulum izlenmedi. Kemik survey ve MR ile kemik tutulumu açısından yapılan korelasyonda MR lehine istatistiksel anlam tespit edildi. (p=0.002) Ayrıca kemik survey ile BT nin kemik lezyon tespitinde benzer oranda değerli olduğu saptandı. (p=0.047)
Pozitron Emisyon Tomografisi-Bilgisayarlı Tomografi (PET-BT) çekilen hastaların 34 ünde kemik surveyi de çekilmiş olup; 31 hastada her iki tetkikle de kemik lezyonu mevcut iken, 3 tanesinde tutulum saptanmadı. PET-BT in kemik surveye kıyasla kemik tutulumu açısından daha üstün olduğu gözlendi (p=0.002). 
PET-BT çekilen 17 hastanın MR çekildiği ve bu hastalardan 14 ü her ikisinde de pozitif iken 1 tanesinin ise her ikisinde negatif oldugu saptandı. PET-BT ile tutulum saptanan 2 hastada MR ile tutulum saptanmadi. PET-BT ve MR tetkikleri arasında kemik tutulumu açısından istatistiksel fark gözlenmedi (p=0.24). 
BT çekilen 67 hastanın 50 sinde kemikte lezyon saptandı. Hem PET-BT hem de BT çekilen 15 hasta saptandı. 2 hastada tutulum yoktu, 13 hastada ise her iki tetkikle de kemik lezyonu mevcuttu. PET-BT ve BT tetkikleri arasında kemik tutulumu açısından PET-BT lehine istatistiksel fark gözlendi (p=0. 047).
PET-BT çekilmiş hastaların toplam sağkalımları incelendiğinde 33 ay, Progresyon Free Survial (PFS)1 15 ay, PFS2 19 ay, PFS3 19 ay ve PFS4 5,6 ay olarak izlendi.

Abstract:
In this study, 195 multiple myeloma diagnosed patients followed in Hematology Clinic of Dokuz Eylül University Medical Faculty Hospital between the years of 2005-2015 were examined retrospectively. Treatment responses, bone manifestations of the patients and radiological screening methods used to detect these were reviewed and it was aimed to contribute to the literature. 
The average age of the patients was 59, of whom 109 were male, and 86 were female. A statistically significant difference was detected between the patients ISS stage and average survival time (p<0.001).
It was observed that bone survey was performed on 187 patients of us. The lytic bone lesion was not detected in 56 patients, lytic area involvement was detected to be <5 area in 80 patients and the lytic bone area was detected to be more than >5 area in 51 patients. 
It was observed that Magnetic Resonance Imaging (MRI) was used in 73 patients. Involvement was not observed in 10 patients. In the correlation made between bone survey and MRI in terms of bone involvement, statistical significance was detected on behalf of MRI (p=0.002). Furthermore, in bone survey and bone lesion detection with CT, it was detected to be valuable in similar rates (p=0.047).
34 of the patients who had Positron Emission Tomography Computer Tomografi (PET) had bone survey, and 31 patients had bone lesion according to both investigations, 3 of them did not have involvement. It was observed that PET was superior to bone survey in terms of bone involvement (p=0.002).
It was detected that 17 patients who had PET, had MRI, and while 14 of these patients were positive in both of them, 1 patient was negative in both of them. In 2 patients who were diagnosed with involvement via PET, involvement could not be detected via MRI. A statistical difference was not observed between PET and MRI investigations in terms of bone involvement (p=0.24).
Lesion in bone was detected in 56 of 67 patients who had CT. There were 15 patients who had both PET and CT. There was not involvement in 2 patients, but in 13 patients bone lesion existed via both investigations. A statistical difference between PET and CT investigations was observed in terms of bone involvement on behalf of PET (p=0.047).
When total survivals of patients who had PET were examined, it was 33 months, Progression Free Survival (PFS)1 was 15 months, PFS2 was 19 months, PFS3 was 19 months and PFS4 was observed to be 5,6 months.