摘要
Summary Multiple Myeloma(MM)is characterised by the accumulation of malignant plasma cells in the bone marrow producing a monoclonal immunoglobulin.The standard conventional therapy is the combination of melphalan and prednisone resulting in a response rate of 40%-60%and in a median survival time of approximately 3 years.In order to improve the therapeutic efficacy various combination regimens have been tested.Most randomized trials have frailed to show a significant improvement in survival time when combination chemotherapy is used instead of melphalan with or without prednisone.The benefit of maintenance therapy with interferon-alpha has been demonstrated.The toxicity of interferon-alpha,which may reduce the quality of life,should be considered.Recently,myeloma-treatment has been modified.High-dose chemotherapy accompanied by hematopoietic stem-cell support via autologous transplant is recommended up to the age of 65-70 years.First results from a French study comparing single versus double autologous transplantation have shown a benefit in terms of event-free survival for the sequential approach.Vaccinations as an adoptive immuntherapy to treat minimal residual disease are under way.The mortality rale of allogeneic transplantation of hematopoietic stem cells has been reduced in the last 5 years.The use of reduced conditioning regimens or the partial depletion of T cells in peripheral blood stem cell transplants in an effort to decrease transplant related mortality are promising approaches.Thalid-omide and its derivates are a new class of agents with independent anti-tumour activity in MM.Encouraging results with this antian-giogenic therapy in phase II trials have been reported.Supportive therapies,such as the treatment of anaemia with erythropoietin,the management of renal failure and the use of bisphosphonates,improve the life quality of MM patients.
目的多发性骨髓瘤是以骨髓内恶性浆细胞聚集而产生单克隆免疫球蛋白为特点的一种疾病。一般保守疗法是采用左旋苯丙氨酸联合强的松用药,有效率可达40%~60%,平均存活时间大约为3年。为进一步提高疗效,临床上曾尝试多种治疗方案,发现使用联合化疗方案与单用左旋苯丙氨酸及左旋苯丙氨酸加强的松相比,能有效地延长患者的生存时间。α-干扰素有较好的支持治疗作用,但α-干扰素的毒副作用对降低患者的生活质量,应引起重视。近来骨髓瘤治疗方法有改进。在65~70岁年龄组患者中推荐大剂量化疗联合经自体造血干细胞移植的治疗方案。最先的一项来自法国的研究结果表明,比较单自体移植对双自体移植,对在后继的无病生存方面的研究有帮助。作为过继免疫疗法的免疫接种是为了治疗小的残余病灶,目前正在进行中。在过去的5年里,同种异体干细胞移植的死亡率已明显下降。采用减少预治疗或外周干细胞移植中T细胞的部分剔除可降低与移植相关的死亡率,是一种有前途的研究方法。酞胺哌啶酮及其衍物作为一类新的药物,在多发性骨髓瘤的治疗中具有独到的抗肿瘤活性作用。抗血管生成治疗已有Ⅱ期实验报道,这一结果令人鼓舞。通过使用促红细胞生成素治疗贫血、肾功能衰竭的防治及磷酸二酯的应用等支持疗法,可以进一步提高多发?
基金
Corespondence:Prof.Dr.A.D.Ho,Department of Intermal Medicine V,University of Heidelberg,Hospitalstr.3 D 69115 Heidelberg,Germany.Tel:49(0)6221-568003,Fax
49(0)6221-565813.Email:A.D.Ho@med.uni一heidelberg.de
