Prognostic factors with high-dose melphalan for refractory multiple myeloma [see comments]
Prognostic factors with high-dose melphalan for refractory multiple myeloma [see comments]
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高剂量马法兰治疗难治性多发性骨髓瘤的预后因素[见评论]
DOI：
10.1182/blood.v72.6.2015.2015
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发表时间：
1988
期刊：
影响因子：
20.3
通讯作者：
F. Cabanillas
中科院分区：
文献类型：
--
作者：
B. Barlogie;R. Alexanian;L. Smallwood;B. Cheson;D. Dixon;K. Dicke;F. Cabanillas
43例晚期多发性骨髓瘤患者接受高剂量美法兰（HDM）和地塞米松治疗，其中36例患者对标准美法兰-强的松和长春新碱-阿霉素-地塞米松（VAD）均难治。44%的患者计算出的肿瘤体积减少了75%以上，其中包括3名完全缓解的患者。18例复发患者对HDM的有效率为56%，12例原发性耐药不足12个月的患者对HDM的有效率为50%，而其余13例无反应患者对HDM的有效率仅为23%。26例表现不佳（Zubrod大于1）或肾功能受损（肌酐大于1.4 mg%）的患者早期死亡率高达30%。当21例表现良好（Zubrod小于2）且疾病缺乏高血清乳酸脱氢酶（小于或等于500 U/L）作为最近公认的高级骨髓瘤特征的患者接受这种毒性治疗时，获得了18个月的中位生存期，而其余22例患者仅为3个月（P < 0.001）。因此，当及时使用HDM时，HDM克服了对标准化疗和VAD的耐药性，并使选定的晚期骨髓瘤患者受益。
High doses of melphalan (HDM) and dexamethasone were administered to 43 patients with advanced multiple myeloma, 36 of whom were refractory to both standard melphalan-prednisone and vincristine-adriamycin- dexamethasone (VAD). Forty-four percent responded with greater than 75% reduction in calculated tumor mass, including three patients who achieved a complete remission. The response rate to HDM was 56% in 18 relapsing patients and 50% in 12 patients with less than 12 months of primary drug resistance, but it was only 23% among the remaining 13 unresponsive patients. A high early mortality rate of 30% was confined to 26 patients with either poor performance (Zubrod greater than 1) or impaired renal function (creatinine greater than 1.4 mg%). When this toxic treatment was given to the 21 patients with good performance (Zubrod less than 2) whose disease lacked high serum lactic dehydrogenase (less than or equal to 500 U/L) as a recently recognized feature of high-grade myeloma, a superior median survival of 18 months was obtained as opposed to only 3 months for the 22 remaining patients (P less than .001). Thus, when employed in a timely fashion, HDM overcomes resistance to standard chemotherapy and VAD and benefits selected patients with advanced myeloma.