Comprehensive treatment of multiple myeloma, multiple myeloma treatment must develop a comprehensive treatment of clinical stage. I asymptomatic and stable condition can be temporarily in patients with chemotherapy, close follow-up, E should be in strong support of the treatment of patients under chemotherapy, and pay attention to prevent pathologic fractures, hypercalcemia, high uric acid and high azotemia such complications.
1. Maintenance treatment
Almost all patients with complete remission in 1 – 2 years, recurrence, chemotherapy does not prolong the maintenance of remission or survival, and maintenance of drug resistance in patients with relapsed after chemotherapy increased the proportion of interferon can delay the recurrence, but can not significantly prolong survival .
Comprehensive treatment of multiple myeloma 2. Immunotherapy
Remission induction therapy with interferon alone, untreated MM with efficiency of 10% – 30%, 1 – 10 months markedly, but it is difficult to be effective in refractory cases. Interferon combined with chemotherapy better than single effect, the efficiency of untreated patients had increased to 80 '% or more. Interferon use is (3 – 5) X 106u, subcutaneous or intramuscular injection 3 times per week for 4 weeks or more, the general election in the interval of chemotherapy drugs.
3. Bone Marrow Transplantation
Although modern chemotherapy can significantly prolong survival, but failed to cure multiple myeloma . In recent years, disease-based bone marrow transplantation has become an important treatment.
(1) multi-use high-dose conditioning regimen MEL CloO—-14Omg/m2) and total body radiotherapy (TBI, 8.0 ~ 12.OGy).
(2) allogeneic bone marrow transplantation in Europe and America and other countries reported that a group of 101 cases of allogeneic bone marrow transplantation (allo-BMT), 50% ~ 75% as high risk, refractory patients, median time from diagnosis to transplant 19 to 20 months The results 61% achieved complete remission, the median response of 48 to 60 months, 3 year disease-free survival rate of 40%, transplant-related mortality rate 16% 0 1995 Barlogie comprehensive analysis of 268 cases of allo-BMT treatment of MM data, CR rate 35% 5-year disease-free survival rate was 35%, transplant-related mortality rate as high as 40%.
(3) autologous stem cell transplantation in a large sample of clinical studies have demonstrated that autologous stem cell transplantation can improve the CR rate and prolong survival time. ASCT, including autologous bone marrow transplantation (ABMT) and autologous peripheral blood stem cell transplantation (AP ~ perusal.. Generally choose a large number of anti-tumor cells after chemotherapy, bone marrow hematopoietic function of bone marrow collected in the recovery period, the use of lID-CTX (6.Og/m2 ) + G-CSF for mobilization of the blood cell separator in peripheral blood stem cell collection.
Application of European and American centers 8 AS (established first-line treatment of 571 cases, mostly in the diagnosis to transplant time of 12 months, with a median age of 50 years median follow-up of 24 months, CR rate of 42% (22% – 77%) The median disease-free survival of 30 months, transplant-related mortality rate 5%, PBSCT and ABMT long-term efficacy is similar. transplant before the 132-MG level of sensitivity to chemotherapy, transplant effect is the main factor of long survival.
ASCT main issues are:
the current conditioning regimen is difficult to completely remove the tumor cells in vivo.
Comprehensive treatment of multiple myeloma, transfusion of bone marrow or political exchange with tumor cells. Both the high relapse rate after ASCT is the reason. CD really positive selection in vitro to reduce tumor cells PBSC 2.7 — 4.5 logarithmic level, in vitro purification of monoclonal antibodies is not yet sure.