Proteasome inhibitor bortezomib has a very powerful anti-myeloma effect on both preclinical and clinical trails.it has been widely used in the treatment of newly diagnosed,refractory and relapse multiple myeloma.Its side effects were well tolerant and manageable.

2014 International Myeloma Working Group (IMWG) summit was held in Milan at June 2014.During this meeting,the criteria of asymptomatic and symptomatic multhiple myeloma was revised.No benefit was shown with conventional treatment for asymptomatic patients.Frontline therapy in newly diagnosed multiple myeloma,also in elderly patients was discussed.Individualized treatment,especially for genetic risk stratification should be done,but randomized control studies needed to be done to confirm its feasibility.

Objective To assess the role of combined use of laparoscopy with diagnostic peritoneal lavage (DPL) in the diagnosis of abdominal stab injury (ASI). Methods From March 2005 to June 2010,21 cases of abdominal and thoracoabdominal stab injuries were analyzed retrospectively.All the cases were diagnosed laparoscopically first.If no significant injury was detected,1 000 ml of normal saline was infused through the abdominal trocar into the peritoneal cavity and routine/regular study on RBCs,WBC,amylase and bile of the effluent fluid was made. ResultsLaparoscopic diagnosis was positive in five cases,including two cases of diaphragmatic injuries,one traumatic bleeding of liver capsule,one small intestinal perforation and one stomach wall perforation.Laparoscopic diagnosis was negative in 16 cases,of which two were detected as intestinal perforation and repaired by laparotomy.The operation time was (120 ± 35.6) min and the hospital stay was (5.3 ± 3.4) d.There were no major complications after operation. Conclusion Combining the visual advantage of laparoscopy with the sensitivity and specificity of DPL can effectively improve the diagnosis of ASI.

The 48th annual meeting of the American Society of Clinical Oncology (ASCO) was held in Chicago from June 1-5 2012 and the risk-adapted therapy of multiple myeloma (MM) was discussed.MM is a heterogeneous disease and all patients should be accepted risk-adapted therapy. According to cytogenetic abnormalities, MM patients are divided into three groups,standard risk, intermediate risk and high risk.Patients with standard risk may received 4 cycles Rd regimes (lenalidomide plus low dose dexamethasone) or VCD regimes (bortezomib,cyclophosphamide,dexamethasone) for induction therap.Patients with intermediate risk may received 4 cycles VCD regimes for induction therapy.Patients with high risk may received 4 cycles VRD regimes (bortezomib,lenalidomide,dexamethasone) for induction therapy.After induction treatment,patients can received autologous hematopoietic cell transplantation or consolidation/maintenance therapy. The determination of which patients are eligible for autologous hematopoietic cell transplantation according age,comorbidities and performance status.

Multiple myeloma is a malignancy of plasma cells and renal function impairment is one of common complications of multiple myeloma.Light-chain deposition in renal tubules which induces renal tubular disease is the major pathogenesis of renal impairment.The renal function impairment should be estimated based on glomerular filtration rate in multiple myeloma patients. Bortezomib with high-dose dexamethasone is effective to myeloma patients with renal impairment and improves renal function.Treatment experience of thalidomide is limited,but it can be used at the standard dosage to patients with renal failure.Lenalidomide is effective and can reverse renal impairment of several myeloma patients when this agent is used at reduced doses according to renal function.

Objective To understand the cause and pathogenesis,clinical and pathological features,diagnosis,treatment and prognosis of Casdeman's disease (CD). Methods One patient with CD which has transformed into Hodgkin's lymphoma in the end was analysed and the review were included. Results Castleman' s disease was a lymphoproliferative disorder with benign hyperplastic lymphnodes histologically characterized by follicular hyperplasia and capillary proliferation with endothelial hyperplasia. Based on the characteristic of pathology it was subdivided into three subtypes, hyaline vascular variant, plasma cell variant and mixed variant. The clinical manifestation of CD was multiplicity,including the lymphadenectasis and the involvement of the muhisystem of the body. The early diagnosis was depended on the histopathology,and the different histopathology has the distinct prognosis. The prognosis of local Castleman's disease (LCD) was good but the muhicentric Casdeman's disease (MCD) was poor. Conclusion The different histopathology of CD were determined according to the different clinical manifestations and prognosis.

Multiple myeloma is a plasma cell malignancy.At diagnosis,most patients are older than 65 years,In newly diagnosed myeloma patients younger than 65 years,high-dose of melphalan followed by autologous stem cell transplantation(ASCT)is regarded as the standard treatment.In elderly patients,usually older than 65 years,oral melphalan and prednisone(MP)has been considered as the standard regimen recently.However,the discovery of thalidomide,lenalidomide,and the proteasome inhibitor bortezomib will increase the effect of clinical treatment.This review will summarize literatures and focus on the treatment of newly diagnosed myeloma.

Multiple myeloma (MM) is a heterogeneous disease.The prognosis of MM varied a lot among different patients.One of the main basis of risk stratification is genetic abnormality,which including the number or structure anomaly of chromosomes,genetic aberrations,signaling pathway disorders and epigenetic changes.The risk stratification is being revised with the development of FISH,gene-expression profiling and next-generation sequencing.These combined approaches would hopefully transform the current one-for-all care into a more tailored,individual therapeutic strategy for MM patients and would finally improve their quality of lives.

As the introduction of novel agents,the median overall survival of elderly newly diagnosed multiple myeloma patients has increased roughly from 30 to 60 months.But patients with high risk prognostic features still have a poor clinical outcome.This paper which combined the 19th annual congress of the European Hematology Association (EHA) reviews the advances in elderly patients with newly diagnosed multiple myeloma,including standard of care,the way to treatment and prognostic factors.

Autologous stem cell transplantation (ASCT) has been considered as frontline therapy for patients with multiple myeloma (MM) based on the increased rate of response and prolonged progression-free survival compared with conventional chemotherapy.In the recent years,the favorable results shown by newdrug-based multidrug inductions,consolidations,and long-term maintenance approaches have challenged the role of ASCT.Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has shown to be a potentially curative treatment for MM.However,the effectiveness of high-dose conditioning with conventional allo-HSCT is compromised by transplant-related mortality (TRM).Nonmyeloablative transplantation has showed reduced TRM and promising graft-versus-myeloma effects,but rates of acute and chronic graft-versus-host disease remain high.This article provides an overview of clinical trials and aims to define the role of stem cell transplantation in the era of novel agents.