Barlogie B
Arkansas Cancer Research Center, Little Rock 72205, USA.
Semin Hematol. 2001 Apr;38(2 Suppl 3):21-7. doi: 10.1016/s0037-1963(01)90091-5.
High-dose therapy in multiple myeloma (MM) appears to be superior in terms of event-free survival and overall survival compared with conventional therapy. Melphalan-based high-dose therapy increases complete remission rates from 5% to 50% and extends event-free survival beyond 3 years and overall survival beyond 6 years. Critical disease features associated with durable complete remission, event-free survival, and overall survival include the absence of chromosome 13 deletion, low beta(2)-microglobulin, and low C-reactive protein levels. Data on 1,000 patients enrolled in tandem high-dose trials show that chromosome 13 deletion is an important prognostic feature. The timely application of a second cycle of high-dose therapy extends event-free survival and overall survival markedly in MM patients with low beta(2)-microglobulin levels. Long-term results of the total therapy trial indicate that patients who do not have chromosome 13 deletions and present with low C-reactive protein and beta(2)-microglobulin levels have longer complete remissions than patients lacking these prognostic factors. Thalidomide shows clear evidence of antitumor activity possibly because of its antiangiogenic activity. Magnetic resonance imaging (MRI) indicates that bone marrow lesions become smaller or disappear while patients receive dexamethasone, cyclophosphamide, etoposide, and cisplatin (DCEP) consolidation chemotherapy and that patients who have a compete remission after diagnostic MRI have a superior event-free and overall survival than those who still have persistent MRI lesions. Prospective trials are underway to evaluate the effectiveness of consolidation therapy (total therapy II).
与传统疗法相比，多发性骨髓瘤（MM）的大剂量疗法在无事件生存期和总生存期方面似乎更具优势。基于美法仑的大剂量疗法可将完全缓解率从5%提高到50%，并将无事件生存期延长至3年以上，总生存期延长至6年以上。与持久完全缓解、无事件生存期和总生存期相关的关键疾病特征包括不存在13号染色体缺失、低β2微球蛋白和低C反应蛋白水平。纳入串联大剂量试验的1000名患者的数据表明，13号染色体缺失是一个重要的预后特征。对于β2微球蛋白水平低的MM患者，及时应用第二个周期的大剂量疗法可显著延长无事件生存期和总生存期。总疗法试验的长期结果表明，不存在13号染色体缺失且C反应蛋白和β2微球蛋白水平低的患者比缺乏这些预后因素的患者有更长的完全缓解期。沙利度胺显示出明显的抗肿瘤活性证据，可能是由于其抗血管生成活性。磁共振成像（MRI）表明，在患者接受地塞米松、环磷酰胺、依托泊苷和顺铂（DCEP）巩固化疗时，骨髓病变会变小或消失，并且诊断性MRI后完全缓解的患者比仍有持续性MRI病变的患者有更好的无事件生存期和总生存期。正在进行前瞻性试验以评估巩固疗法（总疗法II）的有效性。
