DHAOx方案治疗难治性或复发性非霍奇金淋巴瘤的临床观察

目的:观察DHAOx方案治疗难治性或复发性非霍奇金淋巴瘤的临床疗效及毒副反应。方法:21例患者接受DHAOx方案(奥沙利铂(L-OHP)130mg.m-2静脉滴入3h,d1;阿糖胞苷(Ara-C)2g.m-2静脉滴入,d2,每12h1次;地塞米松(DXM)20～40mg.d-1静脉滴入,d1～4;21～28d为1个周期)治疗。2周期后评价疗效和毒副反应。结果:完全缓解4例(19.0%),部分缓解8例(38.1%),疾病稳定6例(28.6%),疾病进展3例(14.3%),总有效率为57.1%。主要毒副反应为:Ⅲ～Ⅳ级中性粒细胞下降占33.3%(7/21);Ⅲ～Ⅳ级血小板下降占14.3%(3/21);Ⅰ～Ⅱ级腹泻33.3%(7/21),Ⅲ～Ⅳ级腹泻4.8%(1/21);Ⅰ～Ⅱ度外周神经毒性占81.0%(17/21),无Ⅲ～Ⅳ级外周神经毒性发生;Ⅰ～Ⅱ级恶心、呕吐38.1%(8/21),无Ⅲ～Ⅳ级恶心、呕吐反应;Ⅰ～Ⅱ级肝功能损害19.0%(4/21),无肾功能损害及Ⅲ～Ⅳ级肝功能损害。结论:DHAOx方案治疗难治性或复发性非霍奇金淋巴瘤有效性较高,毒副反应可耐受。     

拓扑替康标准方案与周疗方案治疗小细胞肺癌的荟萃分析

目的 用荟萃（Meta）分析法比较拓扑替康两种治疗方案的临床疗效和安全性,为临床医生在选择化疗方案时提供参考依据.方法 收集自PubMed建库至2013年7月10日发表的有关比较拓扑替康两种治疗方案有效性和不良反应发生率的文献,根据Meta分析的要求对检索到的原始文献进行质量评估,对符合要求的所有文献研究结果进行Meta分析,评估两种化疗方案对小细胞肺癌治疗的有效性和安全性.结果 有3篇文献符合纳入标准,在评价两组方案对患者有效率中总样本量为288例,其中周疗方案组165例,有效17例;标准方案组123例,有效21例.在评价两组方案对患者不良反应发生率中纳入2篇文献,总样本量132例,其中周疗方案组89例,Ⅲ/Ⅳ级粒细胞减少26例,Ⅲ/Ⅳ级血红蛋白减少17例,Ⅲ/Ⅳ级血小板减少18例;标准方案组43例,Ⅲ/Ⅳ级粒细胞减少发生39例,Ⅲ/Ⅳ级血红蛋白减少24例,Ⅲ/Ⅳ级血小板减少32例.两组方案对患者有效率影响中OR=0.49,95％可信区间0.23 ～1.01,跨过无效线;两组方案对患者Ⅲ/Ⅳ级粒细胞减少发生率的影响中OR =0.04,95％可信区间0.01 ～0.14,位于无效线的左侧;两组方案对患者Ⅲ/Ⅳ级血红蛋白减少发生率的影响中OR=0.27,95％可信区间0.11 ～0.63,位于无效线的左侧;两组方案对患者Ⅲ/Ⅳ级血小板减少发生率的影响中OR =0.12,95％可信区间0.04～0.32,位于无效线的左侧.结论 两种化疗方案在有效率方面的差异无统计学意义;周疗方案组在Ⅲ/Ⅳ级粒细胞减少的发生率、Ⅲ/Ⅳ血红蛋白减少的发生率低和Ⅲ/Ⅳ血小板减少的发生率等方面均低于标准方案组,差异有统计学意义.     

小剂量硼替佐米联合化疗治疗4例多发性骨髓瘤的疗效

目的观察小剂量硼替佐米联合化疗治疗复发难治或初发多发性骨髓瘤（MM）的疗效和不良反应。方法4例MM患者接受硼替佐米＋环磷酰胺＋地塞米松＋沙利度胺治疗,每3周为一疗程。所有患者接受2～4疗程的治疗。采用EBMT疗效标准评价疗效,按国立癌症研究所的常规毒性判定标准评价不良反应。结果4例MM患者中1例接近完全缓解,3例部分缓解。不良反应有白细胞减少、血小板减少、肺部感染等。结论小剂量硼替佐米联合化疗可作为复发难治或初发MM的治疗选择。     

替吉奥联合奥沙利铂一线治疗晚期食管癌的临床观察

目的本研究旨在评价替吉奥(S-1)联合奥沙利铂(SOX方案)一线治疗晚期食管癌的临床疗效和毒副反应。方法 SOX方案一线治疗35例食管癌患者。具体用法:替吉奥胶囊60mg,早晚餐后30min口服,连服14d;奥沙利铂130mg/m2加人5%葡萄糖液500m L中静脉滴注3h,第1天;21d为一周期,每2周期按WHO疗效标准评价疗效,所有患者至少接受2周期化疗。结果 35例患者共接受113个周期的化疗,所有患者均可评价疗效。35例患者中无完全缓解病例,部分缓解17例(48.57%),稳定5例(14.29%),进展13例(37.14%),总有效率为62.86%,中位疾病进展时间187d,中位生存时间287d。最常见的不良反应为胃肠道反应及血液系统毒性,Ⅲ~Ⅳ级恶心/呕吐发生率为8.57%,Ⅲ~Ⅳ级粒细胞减少、Ⅲ~Ⅳ级血小板减少、Ⅲ~Ⅳ级贫血的发生率分别为8.57%,5.71%,5.71%;黏膜炎及腹泻多数为轻度,Ⅲ级毒性均为1例,经对症治疗后均可缓解;神经系统毒性较轻微,主要为Ⅰ级,无Ⅲ级以上外周神经毒性发生;肝毒性主要表现为ALT升高,但毒性较轻微,无Ⅱ级以上肝毒性。结论替吉奥联合奥沙利铂方案一线治疗晚期食管癌疗效满意、毒性较低,值得临床应用及进一步大样本、多中心研究。     

VMP方案治疗Ⅲ期妊娠滋养细胞肿瘤疗效分析

目的探讨甲氨蝶呤、顺铂联合长春新碱(VMP)方案治疗Ⅲ期妊娠滋养细胞肿瘤的疗效及安全性。方法 2007年1月—2011年5月,在安徽省立医院接受VMP方案化疗的Ⅲ期妊娠滋养细胞肿瘤患者共52例,回顾性分析这些患者的临床资料,观察该方案治疗的疗效及安全性。结果 52例Ⅲ期妊娠滋养细胞肿瘤患者共接受244个疗程的VMP方案化疗(其中包括86个疗程的巩固治疗),平均疗程4.69个;低危者完全缓解率达100%,高危者达81.8%;主要毒副反应包括骨髓抑制、消化道反应和口腔溃疡等,无严重毒副反应发生。结论 VMP方案用于Ⅲ期妊娠滋养细胞肿瘤治疗,是一种安全有效的方案。     

拓扑替康血液毒性反应的观察与研究

目的:观察拓扑替康的血液毒性反应,评价拓扑替康在临床应用的安全性。方法:113例初次接受3个周期化疗的非小细胞肺癌患者分为三组,TP组53例(拓扑替康0.75mg/m2,顺铂20mg/m2,第1～5天);NP组30例(去甲长春花碱25mg/m2,第1,8天,顺铂20mg/m2,第1～5天);HP组30例(羟基喜树碱6mg/m2,顺铂20mg/m2,第1～5天);21天为1个周期。第3周期末评价血液毒性。结果:化疗有效率TP组39.62%,NP组33.33%,HP组30.00%,组间比较无显著性差异(P>0.05);三组血液毒性反应中,TP组白细胞Ⅲ级下降18例,Ⅳ级15例,Ⅲ～Ⅳ级下降占62.26%,白细胞Ⅲ～Ⅳ级下降与NP和HP组比较均有显著性差异(P<0.05);TP组血小板Ⅲ级下降15例,Ⅳ级下降13例,Ⅲ～Ⅳ级下降占52.83%。血小板Ⅲ～Ⅳ级下降反应与NP组和HP组比较也有显著性差异(P<0.05)。结论:拓扑替康具有较重的血液毒性反应,尤其是Ⅲ～Ⅳ级反应,以白细胞和血小板下降为主。临床应用期间应注意血象监测,适时采取措施,即使发生Ⅲ～Ⅳ级骨髓抑制反应,对患者也是安全的。     

硼替佐米联合VAD方案治疗初治多发性骨髓瘤的临床观察

目的:观察硼替佐米联合VAD方案治疗初治多发性骨髓瘤(MM)的初期疗效和安全性。方法:15例初治MM患者给予硼替佐米1.3mg.m-2,第1、4、8、11天静脉注射,每28天为1个疗程;每个疗程联合VAD方案化疗,每例患者至少接受2～8个疗程治疗。采用欧洲骨髓移植协作组(EBMT)标准评价其初步疗效,按美国国家癌症研究所不良事件常用名标准(NCI-CTCAE,version3.0)判断其毒副反应。结果:15例MM患者经过不同疗程的治疗,3例完全缓解,5例接近完全缓解,5例部分缓解,2例轻微缓解,总有效率达86.7%。最常见的毒副反应为胃肠道反应,有11例出现不同程度的胃肠道反应,其次为周围神经病变4例、乏力4例、肝功能损伤1例、带状疱疹1例,毒副反应分别经对症治疗后均获得一定程度的缓解。结论:硼替佐米联合VAD方案治疗初治MM疗效确切,患者可耐受。     

VTD 方案对难治/复发多发性骨髓瘤患者凝血功能的影响

目的 探讨VTD 方案对难治/ 复发多发性骨髓瘤（multiple myeloma,MM） 患者凝血功能的影响.方法 分别检测硼替佐米治疗前及第1 天、第4 天应用该药物1h 后患者血浆凝血功能和血小板聚集功能,并统计血栓的发生率.结果 28 名难治/ 复发MM 患者治疗前及第1 天、第4天应用硼替佐米1h 后,血浆APTT、PT、TT值无明显变化,AT-Ⅲ、FIB在T、T、T2 时间段虽各有增加,但差异无统计学意义（P〉0.05）.血小板最大聚集率逐步下降,两两间0比较1P〈0.05,差异有统计学意义.28例MM 患者,1 名患者发生了静脉血栓（venous thrombosis,VET）.结论 难治/复发MM 患者经过VTD 方案治疗后,凝血功能无显著变化,但血小板聚集率显著下降,并且呈现药物浓度及时间依赖性.     

以硼替佐米为主的化疗方案治疗复发难治性多发性骨髓瘤临床效果观察

目的 观察硼替佐米为主的化疗方案治疗复发难治性多发性骨髓瘤的近期疗效与安全性.方法 对2009年1月至2012年12月采用硼替佐米联合化疗方案治疗45例复发难治性多发性骨髓瘤患者的临床资料进行回顾性分析.患者中男25例,女20例,年龄37～ 78岁,平均（57±2）岁.其中15例接受PAD（硼替佐米、阿霉素、地塞米松）方案,15例接受PCD（硼替佐米、环磷酰胺、地塞米松）方案,8例接受PD（硼替佐米、地塞米松）方案,7例接受PDT（硼替佐米、地塞米松、沙利度胺）方案.按照欧洲骨髓移植协作组标准评价疗效（EBMT）,世界卫生组织（WHO）标准判断不良反应.结果 随访25（5 ～35）个月,采用PAD方案治疗的15例患者有效率93.3％,其中完全缓解＋接近完全缓解7例、非常好的部分缓解3例、部分缓解2例、轻微反应2例、疾病稳定1例.采用PCD方案治疗15例患者有效率93.3％（14/15）,其中完全缓解＋接近完全缓解7例、非常好的部分缓解3例、部分缓解3例、轻微反应1例、疾病稳定1例.采用PAD与PCD方案有效率差异无统计学意义（P＞0.05）.采用PD方案治疗8例患者有效率75.0％（6/8）,其中完全缓解＋接近完全缓解3例、非常好的部分缓解1例、部分缓解1例、轻微反应1例、疾病稳定1例、疾病进展1例.采用PDT方案治疗7例患者有效率85.7％ （6/7）,其中完全缓解＋接近完全缓解2例、非常好的部分缓解1例、部分缓解1例、轻微反应1例、疾病稳定1例、疾病进展1例.采用PD与PTD方案2组临床疗效差异无统计学意义（P＞0.05）.22例患者出现外周神经病变,主要表现为肢端麻木、感觉减退,其中15例为Ⅰ～Ⅱ级.6例因同时使用硼替佐米、沙利度胺出现肢端麻木,停用沙利度胺后临床症状逐渐缓解,1例为Ⅲ级.主要不良反应为周围神经病变、胃肠道症状、带状疱疹及感染、血液系统不良反应、乏力、脱发.但通     

新辅助化疗应用于局部晚期宫颈癌手术前治疗的临床效果观察

目的 观察局部晚期宫颈癌新辅助化疗的疗效及应用价值.方法 局部晚期宫颈癌(Ⅰb2～Ⅱb期)的患者中18例采用CBP方案化疗作为研究组,22例采用VBP方案化疗作为对照组,2组化疗1～2个疗程后观察近期有效率、化疗的不良反应以及根据近期疗效予以进一步手术或放疗.结果 CBP方案化疗组有效者16例,总有效率88.9％,VBP方案化疗组有效者20例,总有效率90.9％.2组对比化疗的总有效率差异无统计学意义(P＞0.05).在不良反应方面,2组对比可见CBP方案化疗组的Ⅱ级及以上的胃肠道反应和骨髓抑制均小于VBP方案化疗组,CBP方案胃肠道反应Ⅱ级5个疗程,Ⅲ级2个疗程,骨髓抑制Ⅱ度2个疗程,Ⅲ度0个疗程;VBP方案胃肠道反应Ⅱ级10个疗程,Ⅲ级7个疗程;骨髓抑制Ⅱ度7个疗程,Ⅲ度2个疗程,(P＜0.05);而肝肾功能损害2组差异无统计学意义(P＞0.05).结论 以铂类为基础的联合方案CBP、VBP应用于局部晚期宫颈癌手术前的治疗证实是有效可行的,可使宫颈癌灶缩小,提高了患者的手术切除率及生存质量.而CBP方案化疗组的不良反应较小,对耐受性差、体质弱的患者可优先考虑.     

Estudio observacional restrospectivo para evaluar la efectividad y seguridad de esquemas de tratamiento con bortezomib para el mieloma múltiple en nuestro hospital

ObjectivesTo analyse therapeutic regimens including bortezomib used in our centre for the treatment of multiple myeloma, to evaluate its effectiveness and safety in clinical practice in our hospital, and to assess the appropriateness of the indications described in guidelines.Material and methodsRetrospective analysis of patients diagnosed with multiple myeloma in the period between January 2008 and December 2009 (24 months) that received treatment with a regimen including bortezomib. We analysed demographic variables (age, sex), disease characteristics (type of multiple myeloma, stage, and clinical cytogenetic abnormalities), concomitant drugs, response, and side effects of the regimen including bortezomib.ResultsWe included 59 patients who were diagnosed with multiple myeloma (25 males and 34 females) with an average age of 63 years (range 30-82 years). The overall response rate for patients who received first-line regimens with bortezomib ranged between 69% (vincristine, carmustine, cyclophosphamide, melphalan and prednisone / vincristine, carmustine, doxorubicin, and dexamethasone plus bortezomib) and 82% (bortezomib, melphalan and oral prednisone). When we analysed the salvage treatment regimens: Bortezomib-Dexamethasone, Bortezomib-Cyclophosphamide-Dexamethasone and bortezomib, doxorubicin, melphalan alternating with thalidomide, cyclophosphamide, and dexamethasone achieved overall response rates of 72%, 77% and 89%, respectively. Adverse reactions to bortezomib or a treatment regimen that included it occurred in 32 (54%) patients, highlighting neurotoxicity in 19 patients (32%) and gastrointestinal toxicity in 12 (20%).ConclusionsThe results of our study show the important role of bortezomib in the treatment of multiple myeloma, with response rates and side effects comparable to published data, although the conditions for using it in clinical practice are not yet recognized in the guidelines for use.     

不同剂量硼替佐米治疗多发性骨髓瘤的近期疗效观察

目的观察不同剂量硼替佐米治疗多发性骨髓瘤的近期疗效和不良反应。方法 41例多发性骨髓瘤患者均给予硼替佐米为主的化疗方案治疗(硼替佐米1.0~1.3mg·m-1·d-1,第1、4、8、11天;多柔比星20mg/d,第1~4天;地塞米松20~40mg/d,第1~4天;联合或不联合沙利度胺100mg每晚睡前服用;21d为1个疗程)。根据硼替佐米应用剂量分为高剂量组(1.3mg·m-1·d-1)20例和低剂量组21例(1.0mg·m-1·d-1),患者分别接受1~6个疗程的治疗。结果 41例患者给予不同剂量硼替佐米化疗方案后,高剂量组总有效率为85.0%高于低剂量组的71.4%,差异有统计学意义(P<0.05)。高剂量组出现不良反应14例,低剂量组出现不良反应10例,2组比较差异无统计学意义(P>0.05)。结论硼替佐米应用高剂量(1.3mg·m-1·d-1)时对多发性骨髓瘤的临床疗效更好,虽有一定不良反应,但患者耐受良好。     

硼替佐米联合沙利度胺治疗复发、难治性多发性骨髓瘤的疗效与安全性观察

目的:观察硼替佐米联合沙利度胺治疗复发、难治性多发性骨髓瘤的疗效与安全性.方法:收集我院2007年3月至2010年12月采用硼替佐米联合沙利度胺方案治疗复发、难治性多发性骨髓瘤患者的临床资料进行回顾性分析.治疗方法为硼替佐米1.3 mg/m2,于第1、4、8、11天静脉注射;沙利度胺100 mg/d,口服;21 d为1个疗程.依据欧洲血液及骨髓移植组标准判定疗效,按CTCAE Version 3.0标准评价不良反应.结果:共有66例复发、难治性多发性骨髓瘤患者接受硼替佐米联合沙利度胺治疗,除外因个人原因未完成治疗的7例患者,共有59例患者的资料纳入分析.59例中男37例,女22例,中位年龄51(30 ～64)岁.中位疗程数为6(2～8),中位观察期5(2～10)个月,59例患者中有6例获得完全缓解,12例获得部分缓解,20例获得轻微缓解,总有效率为64.4％.最常见不良反应为胃肠道症状(42例,其中出现不同程度恶心或呕吐36例次,腹泻29例次),其他不良反应为乏力(37例)、血小板减少(23例)、肢端麻木(18例)、发热(15例)、憋气、心慌(5例)、体位性低血压(4例),有1例患者出现视觉障碍.经减少用药剂量或停药及对症治疗后均获缓解.结论:硼替佐米联合沙利度胺是治疗复发、难治性多发性骨髓瘤的有效方法,同时具有较好的安全性.     

New generation pharmacotherapy in elderly multiple myeloma patients

Background: Observational databases have demonstrated that the overall prognosis of multiple myeloma patients has markedly improved over the past decade, yet the greatest strides have been attained in younger rather than older patients. Objective: To review recent clinical trials that include new generation agents (thalidomide, lenalidomide and bortezomib) and autologous stem cell transplantation in older multiple myeloma patients. Results: Conventional regimens such as melphalan plus prednisone can be improved with the addition of thalidomide or bortezomib: more patients attain complete and near-complete remission, and progression-free survival rates are nearly doubled. In addition, autologous hematopoietic stem cell transplantation studies show that this treatment approach can be used successfully in selected older myeloma patients in whom the toxicity profile of autotransplant and resulting overall survival may be similar to that obtained in the younger patient group. Conclusions: In the advanced-age population, implementation of new therapies results in significant benefits in older as well as younger patients.     

Lovastatin and thalidomide have a combined effect on the rate of multiple myeloma cell apoptosis in short term cell cultures

Objective Multiple myeloma is characterized by an accumulation of plasma cells in bone marrow. Despite many therapeutic regimens introduced recently, the prognosis for patients suffering from treatment-resistant or relapsing multiple myeloma is still very poor. Thus, there is an urgent medical need for novel innovative drugs. Thalidomide is successfully used in resistant or relapsing myeloma patients, being reported to induce apoptosis or G1 growth arrest of myeloma cells and to regulate microvessel density and cytokine secretion. Lovastatin, largely used for the treatment of hypercholesterolemia, is another promising drug in multiple myeloma. High doses of lovastatin have been shown to have antiproliferative effect by inhibition of malignant cell proliferation and inducing programmed cell death. Methods In this study, we tried to assess whether thalidomide and lovastatin had a combined effect on apoptosis of myeloma cells. We analyzed apoptosis induced by mixture of these two drugs in short-term cell culture of myeloma plasmocytes. To assess apoptosis, we used Annexin V and propidium iodide binding. We also examined the regulation of BCL-2 and BAX protein expression in the population of CD138+ plasmocytes. The cells were analyzed with the use of flow cytometry technique. The experiments were done before and after 72 h of cell culture. Results We detected a higher rate of apoptosis induced by lovastatin and thalidomide mixture in comparison to apoptosis induced by lovastatin or thalidomide alone. In most patients, the BCL-2/BAX ratio was lower in cell cultures supplemented with mixture of lovastatin and thalidomide in comparison with cell cultures supplemented with lovastatin or thalidomide alone. Conclusion Based on our research we conclude that the mixture of lovastatin and thalidomide may increase the rate of multiple myeloma cells apoptosis in comparison to the single drug and the precise mechanism of this effect should be approved by further research.     

多发性骨髓瘤伴中枢神经系统浸润1例并文献复习

目的 探讨多发性骨髓瘤(MM)患者并发中枢神经系统(CNS)浸润的临床特点,提高对该病的认识.方法 收集1例MM伴中枢神经系统浸润患者的临床资料,并结合文献进行分析和总结.结果 65岁女性患者,1年半前行血常规、生化、免疫固定电泳、颈胸椎CT、骨髓细胞学等检查确诊为MM.予以两个疗程化疗后达完全缓解,巩固治疗两个疗程后出现复发,再次予化疗后出现头晕、视物旋转等神经系统症状,完善磁共振成像(MRI)检查示颅内占位性病变,性质不能明确.经多学科会诊考虑腰椎穿刺术有诱发脑疝的巨大风险,患者无手术禁忌,行颅内肿块切除和病理活检确认为浆细胞性肿瘤,明确诊断为MM伴中枢神经系统浸润.术后予以辅助全身化疗,疗效不佳,确诊骨髓瘤侵犯中枢4个月后死亡.结论 MM伴中枢神经系统浸润临床表现多样,对于存在高危因素并出现神经系统症状的MM患者,应警惕MM侵犯中枢神经系统的可能.     

Melphalan: old and new uses of a still master drug for multiple myeloma

The treatment of multiple myeloma has seen significant changes from the initial use of melphalan to the introduction of stem cell transplantation and, most recently, to the era of novel targeted agents. Melphalan still remains as a reference drug for combination regimens, including emerging newer therapeutic options, either used at a standard dose for initial or salvage treatments in patients who are not eligible for more intensive therapies, or in conjunction with new molecules within high-dose chemotherapy programs. In this review, the authors analyze old and novel regimens, including melphalan for the treatment of newly diagnosed or relapsed/resistant patients with multiple myeloma in the clinical settings of standard chemotherapy, as well as autologous or allogeneic stem cell transplantation.     

Three cases of bortezomib-resistant multiple myeloma with extramedullary masses

In some patients with multiple myeloma, extramedullary masses may be present at diagnosis or may develop during treatment. Recently, multiple myeloma has been treated using newer therapeutic regimens based on thalidomide and bortezomib. Using these drugs, positive responses to treatment, not found with conventional antineoplastic agents, have been reported along with an improvement in patient outcome. In the present study, we report on three patients with extramedullary masses associated with multiple myeloma. Although all three patients were treated with bortezomib, it was ineffective against the extramedullary masses and the clinical course of the disease differed between the three patients. We propose that the effects of bortezomib on extramedullary masses may differ from case to case and may not be evident in cases of severe disease. Also, the effects of bortezomib may not be evident in the case of myeloma cells that have left the bone marrow microenvironment, similar to thalidomide. In addition, resistance to bortezomib may manifest as extramedullary masses. (160 words in the body of abstract).     

Melphalan: old and new uses of a still master drug for multiple myeloma

The treatment of multiple myeloma has seen significant changes from the initial use of melphalan to the introduction of stem cell transplantation and, most recently, to the era of novel targeted agents. Melphalan still remains as a reference drug for combination regimens, including emerging newer therapeutic options, either used at a standard dose for initial or salvage treatments in patients who are not eligible for more intensive therapies, or in conjunction with new molecules within high-dose chemotherapy programs. In this review, the authors analyze old and novel regimens, including melphalan for the treatment of newly diagnosed or relapsed/resistant patients with multiple myeloma in the clinical settings of standard chemotherapy, as well as autologous or allogeneic stem cell transplantation.