Alexanian R, Dimopoulos M A, Hester J, Delasalle K, Champlin R
University of Texas M.D. Anderson Cancer Center, Houston 77030.
Blood. 1994 Dec 15;84(12):4278-82.
The value of early myeloablative therapy supported by autologous bone marrow or blood progenitor cells was assessed in 72 patients with multiple myeloma who were treated within 1 year of initial therapy. Forty-five patients were consolidated during remission, and 27 patients were treated for primary refractory disease. Outcomes were compared with those of similar patients who did not receive intensive treatment primarily for socioeconomic reasons. Among patients who had responded previously, myeloablative therapy increased the rate of complete remission from 5% to 45% (P < .01) but did not prolong progression-free intervals or survival times. The same treatment controlled the myeloma in 70% of patients with primary resistant disease and prolonged the median survival from 37 to 83 months (P = .03). Intensive treatment for primary resistant myeloma administered later in the disease course resulted in significantly lower response rates and shorter progression-free intervals. Current myeloablative regimens supported by autologous stem cells appeared useful primarily in patients with primary resistant disease during the first year of therapy.
对72例在初始治疗1年内接受治疗的多发性骨髓瘤患者评估了自体骨髓或血液祖细胞支持的早期清髓治疗的价值。45例患者在缓解期进行巩固治疗，27例患者治疗原发性难治性疾病。将结果与主要因社会经济原因未接受强化治疗的类似患者的结果进行比较。在先前有反应的患者中，清髓治疗使完全缓解率从5%提高到45%（P<0.01），但未延长无进展间期或生存时间。同样的治疗使70%的原发性耐药疾病患者的骨髓瘤得到控制，并使中位生存期从37个月延长至83个月（P = 0.03）。在疾病病程后期对原发性耐药骨髓瘤进行强化治疗导致缓解率显著降低且无进展间期缩短。目前自体干细胞支持的清髓方案似乎主要对治疗第一年的原发性耐药疾病患者有用。
