Salmon S E
Cancer Treat Rep. 1976 Jun;60(6):789-94.
A number of cooperative-group and single-institution studies have shown that BCNU used in combination with prednisone alone or with melphalan,cyclophosphamide, and prednisone is useful for remission induction in patients with previously untreated multiple myeloma. In this setting, results with BCNU (and probably CCNU) are as good as (but not superior to)the results obtained to the frequency of remission induction, duration of remission, and survival. BCNU plus prednisone also appears to be equal to melphalan plus prednisone for remission-maintenance therapy, although it is still unclear whether maintenance therapy is superior to discontinuation of therapy during remission. At the present time, the major use of the nitrosoureas in multiple myeloma appears to be for patients who enter remission with conventional alkylating-agent therapy and later relapse. BCNU and CCNU are occasionally effective when used as single agents or in combination with other alkylating agents for relapsing patients. Results of a pilot study at the University of Arizona with low doses of BCNU and adriamycin for patients relapsing on alkylating-agent therapy have been encouraging, with a 54% (seven of 13 patients) incidence of CRs and PRs. The use of this combination in conjunction with vincristine and prednisone for relapsing patients is under investigation by the Southwest Oncology Group.
多项协作组和单机构研究表明，卡莫司汀（BCNU）单独与泼尼松联合使用，或与美法仑、环磷酰胺及泼尼松联合使用，对既往未经治疗的多发性骨髓瘤患者的缓解诱导有效。在这种情况下，卡莫司汀（可能还有洛莫司汀[CCNU]）在缓解诱导频率、缓解持续时间和生存率方面的结果与其他药物相当（但不优于其他药物）。卡莫司汀加泼尼松在缓解维持治疗方面似乎也等同于美法仑加泼尼松，尽管目前仍不清楚维持治疗是否优于缓解期停药。目前，亚硝基脲类药物在多发性骨髓瘤中的主要用途似乎是用于那些经传统烷化剂治疗进入缓解期后又复发的患者。对于复发患者，卡莫司汀和洛莫司汀单独使用或与其他烷化剂联合使用时偶尔有效。亚利桑那大学对接受烷化剂治疗后复发的患者使用低剂量卡莫司汀和阿霉素进行的一项初步研究结果令人鼓舞，完全缓解（CR）和部分缓解（PR）的发生率为54%（13例患者中有7例）。西南肿瘤协作组正在研究将这种联合用药与长春新碱和泼尼松一起用于复发患者。
