Hájek R, Adam Z, Vásová I, Král Z
Department of Internal Medicine, Masaryk University Hospital Brno, Czech Republic.
Acta Med Austriaca. 1996;23(3):85-91.
Melphalan has brought the first improvement in the therapy of multiple myeloma at the beginning of the sixties. The median of survival was prolonged from several months to 3 years. In the following 3 decades new drugs were tested, but no other drug brought better results than melphalan. The comparative studies have proved, that therapy response has been reached more rapidly after polychemotherapy than after monotherapy, but none of the treatment modalities differed in the survival parameters. The significance of interferon alpha for the treatment of multiple myeloma has been tested since the beginning of the eighties. Many clinical trials have brought controversial results. The latest metaanalysis and data published support the indication of interferon alpha for the multiple myeloma maintenance treatment. Important progress in the therapy of multiple myeloma has been done in the nineties. High doses of alkylating cytostatics with the support of autologous peripheral blood stem cells transplantation or bone marrow transplantation enhanced the number of therapy-responses and prolonged the survival. The results of autologous transplantations are so favourable, that this procedure can be recommended as the first line treatment in suitable patients. Allogenic bone marrow transplantation is linked with many complications and therefore this method will be performed only in a limited number of patients. Trials dealing with this new therapy-trends are viewed in this paper.
美法仑在20世纪60年代初为多发性骨髓瘤的治疗带来了首个进展。中位生存期从几个月延长至3年。在接下来的30年里，人们对新药进行了测试，但没有其他药物比美法仑带来更好的效果。比较研究证明，联合化疗比单一疗法能更快达到治疗反应，但在生存参数方面，没有一种治疗方式存在差异。自20世纪80年代初以来，人们一直在测试α干扰素对多发性骨髓瘤治疗的意义。许多临床试验得出了有争议的结果。最新的荟萃分析和已发表的数据支持α干扰素用于多发性骨髓瘤维持治疗的适应证。20世纪90年代，多发性骨髓瘤的治疗取得了重要进展。在自体外周血干细胞移植或骨髓移植的支持下，高剂量的烷化剂细胞抑制剂增加了治疗反应的数量并延长了生存期。自体移植的结果非常有利，以至于该程序可推荐给合适的患者作为一线治疗。异基因骨髓移植与许多并发症相关，因此该方法仅在有限数量的患者中进行。本文探讨了涉及这种新治疗趋势的试验。
