Hjorth M, Holmberg E, Rödjer S, Turesson I, Westin J, Wislöff F
Department of Medicine, Lidköping Hospital, Sweden.
Eur J Haematol. 1999 Apr;62(4):271-7. doi: 10.1111/j.1600-0609.1999.tb01757.x.
The patient registers of five prospective population based Nordic studies were reviewed for patients <60 yr. A total of 313 patients with symptomatic multiple myeloma were identified. Thirty-nine of them were judged retrospectively to have been ineligible for intensive chemotherapy regimens. The remaining 274 patients were considered appropriate as a historical control group for comparison with patients treated with high-dose chemotherapy and autologous stem cell support. Of these, 32 had been diagnosed during the period 1970-83, 101 during the period 1984-89 and 141 during the period 1990-92. The median age was 54 yr. Six percent were Durie/Salmon stage I, 38% stage II and 56% stage III. Melphalan-prednisone was used for initial therapy in 87%. Median survival for all patients with symptomatic myeloma was found to be 41 months, and for those selected for the control group 44 months, with no noted differences between the aforementioned diagnostic periods. We conclude that the expected median survival is 44 months for myeloma patients <60 yr who may be considered for high-dose therapy protocols. New developments in chemotherapy and supportive therapy, achieved during the two decades which preceded the use of high-dose chemotherapy with stem cell rescue, have not changed the overall prognosis in multiple myeloma.
对五项基于北欧前瞻性人群研究的患者登记资料进行了回顾，研究对象为年龄小于60岁的患者。共确定了313例有症状的多发性骨髓瘤患者。其中39例经回顾性判断不符合强化化疗方案的条件。其余274例患者被视为合适的历史对照组，用于与接受大剂量化疗和自体干细胞支持治疗的患者进行比较。在这些患者中，32例在1970 - 1983年期间被诊断，101例在1984 - 1989年期间被诊断，141例在1990 - 1992年期间被诊断。中位年龄为54岁。6%为Durie/Salmon I期，38%为II期，56%为III期。87%的患者初始治疗采用美法仑-泼尼松。有症状骨髓瘤患者的中位生存期为41个月，对照组患者为44个月，上述诊断期间之间未发现明显差异。我们得出结论，对于可能考虑采用大剂量治疗方案的60岁以下骨髓瘤患者，预期中位生存期为44个月。在采用大剂量化疗联合干细胞救援之前的二十年中，化疗和支持治疗的新进展并未改变多发性骨髓瘤的总体预后。
