VMCP和VBAP交替联合化疗治疗Ⅲ期多发性骨髓瘤患者并不优于MP方案

瑞典中部骨髓瘤研究组采用前瞻性随机研究比较了VMCP/VBAP交替联合化疗和MP方案对Ⅲ期多发性骨髓瘤(MM)的疗效.86例初治Ⅲ期MM患者随机分为两组:1.VMCP/VBAP组42例,交替使用VMCP和VBAP方案,间歇期3周,生效后延长至6周.VMCP方案包括长春新碱1mg静注第1天,马法兰5mg/m~2/天,     

长春新碱、阿霉素和地塞米松(VAD)与VAD加重组干扰素α_2治疗难治或复发多发性骨髓瘤的Ⅱ期对比研究

自从1984年应用VAD以来,该方案已成为治疗难治及复发多发性骨髓瘤的标准方案之一。美国东部肿瘤协作组(ECGO)试图确定VAD方案加干扰素(IFN)能否提高难治及复发多发性骨髓瘤患者的有效率或生存率。 治疗方案:对53例难治及复发多发性骨髓瘤患者进行了随机对照研究。VAD方案的用法为:长春新碱0.4mg/d,静脉滴注96小时;阿霉素9mg/m~2·d,持续静脉滴注96小时;地塞米松40mg/d,于奇数疗程的第1～4、9～12、17～20天给予、而偶数疗程仅在第1～4     

VAD方案治疗多发性骨髓瘤和其它恶性淋巴疾患的毒性和疗效

作者用VAD方案治疗多发性骨髓瘤33例,其它恶性淋巴疾患16例以及VAD方案治疗后复发者再给VAD方案治疗3例,共52例可供毒性分析。方法:长春新碱1.6mg+阿霉素36mg/m~2混合静脉滴注,每日1次,连续4天,并口服地塞米松每日40mg,连续4天,隔21天重复。多发性骨髓瘤平均治疗5个疗程,其它恶性淋巴疾患平均给药4个疗程。毒性:恶心10%,体重增加和减轻各占33%,消化不良33%,充血性心力衰竭6%,败血症23%,肺部感染19%。9例死于感染。疗效:33例多发性骨髓瘤有20例达部分缓     

反应停联合VAD方案治疗多发性骨髓瘤疗效评价

目的探讨反应停(沙立度胺)联合VAD(长春新碱、阿霉素、地塞米松)方案治疗多发性骨髓瘤的临床疗效。方法治疗组:反应停100mg/d开始,逐渐增至400mg/d或不能耐受,持续使用,联合VAD化疗。对照组:常规VAD方案化疗。对两组临床疗效进行对比分析。结果治疗组接近完全缓解(nCR)3例,部分缓解(PR)20例,总有效率(ORR)76.7%;对照组nCR1例,PR8例,ORR45.0%。治疗组疗效优于对照组,差异具有统计学意义(P0.05)。结论反应停联合VAD治疗多发性骨髓瘤疗效高、不良反应少,值得推广。     

低剂量反应停联合地塞米松治疗多发性骨髓瘤的临床观察

目的：观察低剂量反应停（thalidomide）联合地塞米松治疗多发性骨髓瘤（MM）的疗效。方法：18例MM患者中10例为初治患者、8例为复发难治性患者。反应停初始剂量为50～100 mg.d-1,每周增加50mg,2周后增加到200 mg.d-1;至少每天100 mg/d,服用3-6个月。同时联合地塞米松10mg.d-1,连服4天,每月1次。结果：完全缓解（CR）3例,部分缓解（PR）6例,微缓解（MR）7例,无效2例。无不能耐受的副反应。结论：地剂量反应停联合地塞米松治疗初发和复发难治性多发性骨髓瘤安全有效。     

难治性和复发性骨髓瘤的治疗进展

经标准方案(马法兰/强的松,MP)治疗至少12个月无效或挽救性方案耐药的复发方确定为真正的难治性多发性骨髓瘤(MM),其中少数患者即使有效亦为时短暂。M_2方案、VAD(长春新碱、阿霉素、地塞米松)方案及中剂量马法兰治疗原发或继发耐药性多发性骨髓瘤平均缓解率大约50%,部分复发性MM仍可获得第二次缓     

反应停治疗难治多发性骨髓瘤的临床研究

目的:观察沙利度胺(thalidomide,反应停)治疗难治多发性骨髓瘤的疗效及副作用。方法:男性5例,女性4例,均为难治性多发性骨髓瘤,反应停治疗起始剂量为100 mg/d,根据患者耐受情况,逐渐加量,最高达400 mg/d。结果:56%(5/9)的患者对治疗有效,其中2例为完全缓解,2例部分缓解,1例进步,2例无效;患者出现不同程度的嗜睡、便秘、头晕、皮疹等副作用。结论:沙利度胺治疗难治性多发性骨髓瘤有效。     

CHOP＋CCNU治疗多发性骨髓瘤25例近期疗效观察

多发性骨髓瘤目前化疗主要是MP、M2、VAD方案，近年来反应停的使用又为本病的治疗开辟了新的方法。上世纪末及本世纪初由于基层医院马法兰药品奇缺，而VAD方案中地塞米松剂量过大，不良反应较多，许多患者不能忍受连续多个疗程的化疗。作者自1995至2002年采用了CHOP（环磷酰胺、阿霉素、长春新碱、泼尼松）＋CCNU（环已亚硝脲）治疗多发性骨髓瘤25例，取得了一定的疗效。现报道如下。     

采用鬼臼乙叉甙、阿霉素、环磷酰胺和大剂量倍他米松作为难治性多发性骨髓瘤门诊患者的补救治疗方案

为寻求简便易行、安全有效适用于门诊治疗难治性多发性骨髓瘤(MM)患者的补救性方案,作者对56例难治性MM患者试用由VAD方案修改而来的(EACB)方案,包括复发性MM20例,原发耐药36例。前治疗有交替联合化疗(VMCP/VBAP)、MP或MP加α-干扰素,从初治直至病情恶化。EACB方案为:鬼臼乙叉甙(E)50mg/m~2iv(输注1小时)第1     

T-VAD和VAD方案治疗多发性骨髓瘤的疗效观察

目的 评价T-VAD(沙利度胺联合VAD方案)和VAD方案治疗多发性骨髓瘤的疗效.方法 64例多发性骨髓瘤患者随机分为2组.VAD治疗组长春新碱加阿霉素加地塞米松;T-VAD治疗组沙利度胺联合VAD方案,沙利度胺起始剂量为200mg/d,每周递增100mg,至患者不能耐受或最高剂量不超过400mg/d.结果 T-VAD治疗组部分缓解(PR)者16例,进步者9例,总有效率83.3%;VAD方案组部分缓解者13例,进步者7例,总有效率58.8%.T-VAD治疗组总有效率高于VAD治疗组(P ＜0.05).结论 T-VAD方案治疗MM总有效率明显高于传统的VAD方案,值得临床深入研究和推广应用.     

Thalidomide

Abstract

Specialist Palliative Care aims to effectively support the quality of life of patients and those close to them through progressive, life-limiting disease. Quality of life, an individual concept, requires a personalized approach to support and maintain it. Primarily achieved through the management of symptoms, both physical and psychological, alongside social and spiritual support, this approach is of the utmost importance to patients with advanced malignancy. Several randomized, controlled trials suggest earlier provision of specialist palliative care may increase quality of life, improve symptoms and facilitate considered end of life care planning. This appears beneficial; however, evidence is mixed about the effectiveness of early specialist palliative care and its potential benefits. Results, therefore, should be interpreted with caution. In reviewing the literature, it is clear that implementing early specialist palliative care is fraught with obstacles and requires increased resources and funding. Until the benefits and cost implications for such provision are better understood, it will not be accessible to all that may have potential to benefit.     

Thalidomide in cancer.

Thalidomide has immunomodulatory and anti-angiogenic properties which may underlie its activity in cancer. After its success in myeloma, it has been investigated in other plasma cell dyscrasias, myelodysplastic syndromes, gliomas, Kaposi's sarcoma, renal cell carcinoma, advanced breast cancer, and colon cancer. Thalidomide causes responses in 30-50% of myeloma patients as a single agent, and acts synergistically with corticosteroids and chemotherapy. Thalidomide results in the reduction or elimination of transfusion-dependence in some patients with myelodysplastic syndrome. Responses have also been seen in one-third of patients with Kaposi's sarcoma, in a small proportion of patients with renal cell carcinoma and high-grade glioma, and in some patients with colon cancer in combination with irinotecan. The drug is being investigated currently in a number of clinical trials for cancer. Drowsiness, constipation, and fatigue are common side effects, whereas peripheral neuropathy and skin rash are seen in one-third. A minority of patients experience bradycardia. Thrombotic phenomena are especially common when thalidomide is combined with chemotherapy. Adverse effects severe enough to necessitate cessation of therapy are seen in around 20% of patients. A therapeutic trial of thalidomide is essential in all patients with relapsed or refractory myeloma. In other cancers, the best way to use the drug is in the setting of clinical trials. In the absence of access to studies or alternative therapeutic options, thalidomide could be considered singly or in combination with standard therapy.     

Thalidomide in multiple myeloma.

Thalidomide--removed from widespread clinical use by 1962 because of severe teratogenicity--has anti-angiogenic and immunomodulatory effects, including the inhibition of TNF alpha. It has returned to practice as an effective oral agent in the management of various disease states including erythema nodosum leprosum, for which it was FDA-approved in 1998, and more recently certain malignancies, including multiple myeloma. Whilst the mechanism of action of thalidomide remains incompletely understood, considerable insight has been generated by extensive preclinical studies in multiple myeloma. Moreover, clinical trials both as a single agent and in combination have confirmed benefit in relapsed and refractory disease. Thalidomide's role in treating newly diagnosed patients is currently under study and it is now established as an important therapeutic option in the treatment of multiple myeloma.     

Thalidomide use in pediatric patients

OBJECTIVE: To provide a detailed overview of thalidomide use in pediatric patients. DATA SOURCES: English-language articles were identified through a MEDLINE search (1966-February 2001); key terms included thalidomide, child, graft-versus-host disease, cancer, HIV, Crohn's disease, Beh?et's disease, and lupus erythematosus. References cited in those articles were also evaluated. DATA SYNTHESIS: Thalidomide appears to be effective in patients with chronic, not acute, graft-versus-host disease (GVHD) and in healing aphthous ulcers in patients with HIV infection. Limited case reports suggest efficacy of thalidomide in the treatment of cutaneous manifestations of Beh?et's disease, Crohn's disease, and lupus in children; however, the recurrence of disease is almost universal on drug discontinuation. CONCLUSIONS: Thalidomide should be used as a last resort when all other therapies fail, preferably in male or prepubescent female patients.