Awedan A, Król M, Blajer B, Rokicka M, Torosian T, Urbanowska E, Wiktor-Jedrzejczak W
Department of Hematology, Oncology, and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
Transplant Proc. 2003 Sep;35(6):2349-51. doi: 10.1016/s0041-1345(03)00829-7.
Current treatment in multiple myeloma consists of three courses of chemotherapy in low doses with subsequent hematopoietic stem cell mobilization to the peripheral blood using high-dose cyclophosphamide, collection and conditioning with high-dose chemotherapy (melphalan) followed by retransplantation of autologous peripheral blood stem cells (PBSCT). Only a few studies compare the effects of different phases of therapy on parameters, such as monoclonal immunoglobulin level and the presence of malignant CD38(+) and CD56(+) cells in blood and marrow. The aim of this study was to compare the effects of these two major phases of treatment (conventional and high dose) in the same patients, and furthermore, to compare the effects of the second course of high-dose therapy followed by PBSCT with the effects of the first one. Fifteen patients were included in the study. On average, conventional chemotherapy only slightly reduced the values of all disease markers. In contrast, high-dose therapy resulted in a dramatic effect, rapidly normalizing the values of all parameters. The effects of second PBSCT were only modest compared to the first. These data suggest that high-dose therapy is an efficient method to reduce tumor load in multiple myeloma. Conventional-dose chemotherapy may be simply a waste of time for some patients and may be either omitted or administered after high-dose therapy to consolidate remission.
目前多发性骨髓瘤的治疗方案包括三个低剂量化疗疗程，随后使用大剂量环磷酰胺将造血干细胞动员至外周血，采集后用大剂量化疗药物（美法仑）进行预处理，然后回输自体外周血干细胞（PBSCT）。仅有少数研究比较了不同治疗阶段对某些参数的影响，如单克隆免疫球蛋白水平以及血液和骨髓中恶性CD38(+)和CD56(+)细胞的存在情况。本研究的目的是比较同一患者这两个主要治疗阶段（传统剂量和高剂量）的效果，此外，还要比较第二次大剂量治疗后进行PBSCT与第一次治疗效果的差异。该研究纳入了15名患者。平均而言，传统化疗仅轻微降低了所有疾病标志物的值。相比之下，大剂量治疗产生了显著效果，使所有参数值迅速恢复正常。与第一次相比，第二次PBSCT的效果仅为中等。这些数据表明，大剂量治疗是降低多发性骨髓瘤肿瘤负荷的有效方法。对于一些患者来说，传统剂量化疗可能只是浪费时间，可在大剂量治疗后省略或进行传统剂量化疗以巩固缓解状态。
