Rokicka M, Urbanowska E, Torosian T, Dwilewicz-Trojaczek J, Awedan A, Paluszewska M, Wiktor-Jedrzejczak W
Department of Hematology, Oncology, and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
Transplant Proc. 2003 Sep;35(6):2352-4. doi: 10.1016/s0041-1345(03)00816-9.
Approximately one third of multiple myeloma patients (below 60 years) are diagnosed either in advanced disease or with significant comorbidities. Many other patients referred to transplant centers have already been heavily pretreated with multiple courses of various conventional chemotherapies. These patients are frequently in bad or even grave clinical condition; they are unlikely to survive standard high-dose melphalan (200 mg/m(3)) chemotherapy and autologous hematopoietic stem cell transplantation. Palumbo et al reported a protocol for elderly patients that utilized reduced conditioning (melphalan 100 mg/m(2) three times at 2-month intervals, each time supported by autologous hematopoietic rescue). We have used this protocol as a start to develop a method to induce a remission in the aforementioned subgroup of myeloma patients. Patients with stage III disease and WHO performance status 2 or higher are treated with one or two cycles of cyclophosphamide (2 to 4 g/m(2)) and undergo peripheral blood stem cells collection. Subsequently, they are treated with three to four doses of melphalan (100 mg/m(2)) at 8- to 12-weeks intervals each time supported by infusion of peripheral blood stem cells. To date 13 patients have been entered into the protocol. With one exception of transiently stable disease, the remaining patients obtained at least partial remission and three, complete remission. The compliance was good and better with each subsequent course. For half of the patients the problem was a short duration of response. This method when developed may offer a new treatment alternative for a subgroup of high-risk multiple myeloma patients.
大约三分之一的多发性骨髓瘤患者（60岁以下）被诊断为晚期疾病或伴有严重合并症。许多转诊至移植中心的其他患者已经接受了多疗程的各种传统化疗。这些患者的临床状况通常很差甚至很严重；他们不太可能在标准的大剂量美法仑（200mg/m³）化疗和自体造血干细胞移植中存活下来。Palumbo等人报告了一种针对老年患者的方案，该方案采用了减低预处理（美法仑100mg/m²，每2个月给药3次，每次辅以自体造血挽救）。我们已将该方案作为起点，来开发一种方法以诱导上述骨髓瘤患者亚组获得缓解。III期疾病且世界卫生组织体能状态为2级或更高的患者接受1至2个周期的环磷酰胺（2至4g/m²）治疗，并进行外周血干细胞采集。随后，他们接受3至4剂美法仑（100mg/m²）治疗，每次间隔8至12周，每次辅以输注外周血干细胞。迄今为止，已有13名患者进入该方案。除1例疾病短暂稳定外，其余患者至少获得部分缓解，3例获得完全缓解。依从性良好，且随着后续疗程越来越好。对于一半的患者来说，问题在于缓解持续时间较短。这种方法一旦完善，可能会为高危多发性骨髓瘤患者亚组提供一种新的治疗选择。
