Gimsing P, Bjerrum O W, Brandt E, Ellegaard J, Evensen S A, Hansen M M, Hedenus M, Hippe E, Keldsen N, Palva I
Department of Internal Medicine and Haematology L, University Hospital, Copenhagen, Denmark.
Br J Haematol. 1991 Jan;77(1):73-9. doi: 10.1111/j.1365-2141.1991.tb07951.x.
In a phase II study, patients with refractory myelomatosis were treated with a combination chemotherapy (NOP regimen): mitoxantrone (bolus injection of 4 mg/m2 on days 1-4), vincristine (continuous infusion of 0.4 mg/24 h on days 1-4) and prednisone (250 mg/d on days 1-4 and 17-20). The treatment was repeated every 4 weeks. Ninety-two patients were treated after they were found refractory to treatment with melphalan and prednisone (and occasionally vincristine) (n = 50) or more intensive treatment regimens (n = 42) including anthracyclines (n = 18). Response (greater than or equal to 50% reduction of M protein) was obtained in 23 patients and minor response (clinical improvement but less than 50% reduction in M protein) in 22 patients. The median duration of the response was 7.5 months. Equal response rates were observed irrespective of the type of previous treatment. The major toxicity was myelosuppression with severe granulocytopenia and infections. However, the frequency decreased throughout the cycles. The NOP treatment is recommended in refractory myelomatosis, especially in patients refractory to other intensive regimens. Patients in a poor clinical condition or with thrombocytopenia before treatment should have a reduced mitoxantrone dose in the first treatment cycles.
在一项II期研究中，难治性骨髓瘤患者接受联合化疗（NOP方案）：米托蒽醌（第1 - 4天静脉推注4mg/m²）、长春新碱（第1 - 4天持续输注0.4mg/24小时）和泼尼松（第1 - 4天及17 - 20天每日250mg）。每4周重复一次治疗。92例患者在被发现对美法仑和泼尼松（偶尔联合长春新碱）治疗（n = 50）或包括蒽环类药物（n = 18）的更强化治疗方案（n = 42）难治后接受治疗。23例患者获得缓解（M蛋白降低大于或等于50%），22例患者获得轻微缓解（临床改善但M蛋白降低小于50%）。缓解的中位持续时间为7.5个月。无论先前治疗类型如何，观察到的缓解率相同。主要毒性是骨髓抑制，伴有严重粒细胞减少和感染。然而，其发生率在整个周期中逐渐降低。推荐NOP方案用于难治性骨髓瘤，尤其是对其他强化方案难治的患者。治疗前临床状况差或有血小板减少的患者在首个治疗周期应降低米托蒽醌剂量。
