Treatment of multiple myeloma

By | January 21, 2012

So far, chemotherapy (chemotherapy) is the most commonly used multiple myeloma is the most basic treatment of multiple myeloma, symptomatic than in the past or simply supported by the efficacy of therapy has been significantly improved. In recent years, using a variety of new drugs and combination chemotherapy, the improvement of efficacy is more obvious than in the past. Such as interferon, monoclonal antibodies, bortezomib (Velcade) and with the same gene into allogeneic bone marrow transplantation therapy is expected to cure the disease. After the treatment, remission or disappearance of symptoms, complications, reduced life expectancy.
Treatment of multiple myeloma (1) chemical treatment: the early asymptomatic patients on chemotherapy should not be, when the clinical symptoms caused by disease progression, chemotherapy should be selected according to the situation. Such as the elderly and infirm, use MP program; general, the better off use M2, VAD program. If chemotherapy after autologous stem cell transplantation, you should not use the program include alkylating agents, such as VAD. Chemotherapy, the efficacy of this disease effects as other hematologic malignancies, efficiency 50%. In advanced myeloma in complete remission with chemotherapy is rare. Nevertheless, chemotherapy is still the most commonly used treatment is the application of reason to be convenient, relatively safe.
Treatment of multiple myeloma (2) radiation therapy: local lesion can be localized radiation therapy. Total body irradiation before bone marrow transplantation is also used for pretreatment, combined with chemotherapy to inhibit graft rejection.
(Creation of blood stem cell transplantation: including autologous stem cell transplantation, which has the same gene in allogeneic hematopoietic stem cell transplantation have achieved a certain effect.
(4) interferon treatment: highly purified recombinant -interferon and inhibit the tumor and the immune anti-tumor cells. Clinical treatment of myeloma effect alone is generally 30%. And chemotherapy may improve the outcome. Can also be used for maintenance therapy after chemotherapy, to prolong remission and survival.
Treatment of multiple myeloma (5) protease inhibitor bodies: bortezomib (bortezomib). Bortezomib is a small molecule of water-soluble dipeptide boronic acid compounds, second-generation protease inhibitor bodies, the growth of tumor cells can arrest cell cycle in S phase and G2 ~ M phase, so that cell division stopped leading to apoptosis.
May 2003 U.S. FDA approval for at least 2 or more received treatment and his condition has deteriorated with recurrent and refractory multiple myeloma (MM) patients.
Dosage and Usage: The recommended dose of this product as a single injection of 1.3 mg/m2, injection of 2 times per week, continuous injection of 2 weeks (that is, in the first 1,4, .1, and 11 days injection) withdrawal after 10 days (ie from 12 days to 21 days). 3 weeks for one course of treatment, doses, interval of at least 72 hours. The product to be completely dissolved with 3.5ml saline 3-5 seconds after the intravenous injection through the catheter, followed by injection with 0.9% sodium chloride solution flush. In clinical studies, patients were confirmed in full force again to receive another injection 2 cycles of bortezomib treatment. Recommend effective in patients receiving 8 cycles of bortezomib for injection therapy.
Foreign reports of 20 cases of recurrent / refractory MM patients. Regimens for the VDD: a single injection of bortezomib 1.3 mg/m2, dl 4 8 and 11 drug delivery, paclitaxel 30mg/m2 cycle, then 1 time per week to bortezomib, dexamethasone, every five weeks a cycle. The results show that, CR + nCR (almost complete remission) 33fJ hair, very good partial response + partial response (VGPR + PR) of 22 ~ hair, mild response (MR) 28 ~ hair, the total effective rate (CR, nCR, VGPR , PR, MR) for the 839 islands, 1 stable disease, 2 cases of disease progression (11%). Show VDD is very effective in the treatment of MM combined treatment.
The most common adverse reaction is weak 65fJ hair (including fatigue, malaise, weakness), followed by nausea (64%), diarrhea (51fJ hair), loss of appetite (43fJ hair), constipation (43%), thrombocytopenia (43%), peripheral neuropathy (37%), fever (36%), vomiting (36%) and anemia (32fJ gross) 0 14fJ hair of patients four serious adverse reactions, such as thrombocytopenia (3%) and neutral neutropenia (3%).
In 2004 the British government approved the drug for the treatment of multiple myeloma.
Based on drug safety, effectiveness, basic research for the drug, extended to other bone marrow-derived tumors and some solid tumors such as lymphoma, prostate cancer, and head and neck tumor treatment. Bortezomib as a single shelf can be treated or combined with other drug use, such as in combination, dexamethasone, L-alanine nitrogen mustard this, Ml etc, and the latter can increase the cytotoxicity of tumor cells, chemotherapy drugs can reduce the amount of 10000 – 100,000 times.
(6) Thalidomide: Thalidomide in recent years in the treatment of multiple myeloma to play a significant role. The number and combination chemotherapy, or as maintenance therapy after chemotherapy.
(7) Surgical treatment: Dangxiong / lumbar osteolytic lesions that occur in patients bedridden and could fracture Erzhi paraplegia, the possible surgical treatment, such as the removal of vertebral disease, artificial vertebral body replacement fixation.
Treatment of multiple myeloma (8) supportive treatment: supportive treatment in multiple myeloma plays an important role.
a. bedridden and so prone to bone decalcification regret, therefore, should encourage appropriate activities with serious thoracic / lumbar spine and a paraplegia risk, the need to limit activities.
b. correction of anemia, thrombocytopenia, may be given blood transfusion, application of EPO; if it was significantly higher Mongolia lag syndrome, plasma exchange can be used.
c. hypercalcemia, calcitonin can be applied, Pamidronate the second pot. In addition, the need to reduce uric acid, protect renal function, prevention of infection.

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