Avilés A, Huerta-Guzmán J, Delgado S, Fernández A, Díaz-Maqueo J C
Department of Hematology, Oncology Hospital, National Medical Center, México, D.F. Mexico, USA.
Hematol Oncol. 1996 Sep;14(3):111-7. doi: 10.1002/(SICI)1099-1069(199609)14:3<111::AID-HON575>3.0.CO;2-G.
Solitary bone plasmacytoma (SBP) is a rare presentation of plasma cell dyscrasias. Radiotherapy has been considered the treatment of choice, however, most patients will develop multiple myeloma, 3 to 10 years after initial diagnosis and treatment. No innovations have been introduced in the treatment of SBP in the last 30 years. We began a prospective clinical trial to assess the efficacy and toxicity of adjuvant chemotherapy with low doses of melphalan and prednisone administered to patients with SBP after radiation therapy in an attempt to improve the disease-free survival and overall survival. Between 1982 and 1989, 53 patients with SBP were randomly assigned to be treated with either local radiotherapy with doses ranged from 4000 to 5000 cGy to achieve local control of disease (28 patients) or the same radiotherapy schedule followed by melphalan and prednisone given every 6 weeks for 3 years (25 patients). After a median follow-up of 8.9 years, disease-free survival and overall survival were improved in patients who were treated with combined therapy, 22 patients remain alive and free of disease in the combined treatment group compared to only 13 patients in the radiotherapy group (p < 0.01). Treatment was well tolerated; planned doses were administered in all cases; no delays in treatment or acute side-effects were observed during treatment. Long-term secondary toxicities including secondary neoplasms and acute leukaemia, have not been observed. We felt that the use of adjuvant chemotherapy after adequate doses of radiotherapy in patients with SBP improved duration of remission and survival without severe side-effects. However, as with other studies in SBP, the group was too small to draw definitive conclusions and more controlled clinical trials are necessary to define the role of this therapeutic approach in patients with SBP.
孤立性骨浆细胞瘤（SBP）是浆细胞发育异常的一种罕见表现形式。放射治疗一直被视为首选治疗方法，然而，大多数患者在初次诊断和治疗后的3至10年将发展为多发性骨髓瘤。在过去30年中，SBP的治疗没有引入新的方法。我们开展了一项前瞻性临床试验，以评估在放射治疗后给予SBP患者低剂量美法仑和泼尼松辅助化疗的疗效和毒性，试图提高无病生存期和总生存期。在1982年至1989年期间，53例SBP患者被随机分配接受治疗，其中28例患者接受剂量为4000至5000 cGy的局部放射治疗以实现疾病的局部控制，另外25例患者接受相同的放射治疗方案，随后每6周给予美法仑和泼尼松，持续3年。中位随访8.9年后，联合治疗组患者的无病生存期和总生存期得到改善，联合治疗组有22例患者仍存活且无疾病，而放射治疗组仅有13例（p < 0.01）。治疗耐受性良好；所有病例均给予计划剂量；治疗期间未观察到治疗延迟或急性副作用。未观察到包括继发性肿瘤和急性白血病在内的长期继发性毒性。我们认为，对SBP患者在给予足够剂量的放射治疗后使用辅助化疗可改善缓解期和生存期，且无严重副作用。然而，与其他关于SBP的研究一样，该组样本量太小，无法得出明确结论，需要更多对照临床试验来确定这种治疗方法在SBP患者中的作用。
