| Objective: Multiple myeloma (MM) is a malignant tumor originated from B cell line, characterized by monoclonal immunoglobulin produced by increased abnormal plasma cells, and the proliferation of malignant bone marrow, causing fractures and bone marrow failure causing clinical symptoms.Without treatment, the median survival time of patients with advanced MM is only 6 months. After receiving conventional chemotherapy, the median survival time is not more than three years, only 25% of patients can survive for more than 5 years, so there is an urgent need for new ways to improve the patient's prognosis. The development of MM treatment has been improved a lot in recent years, such as high-dose chemotherapy, radiation therapy plus autologous hematopoietic stem cell transplant. But for patients with old age, poor general condition or unconditional line of high-dose chemotherapy with autologous hematopoietic stem cell transplantation chemotherapy is still the main thearapy. Since 1969, the use of Melphalan and Prednisone (MP)has become a classic treatment of multiple myeloma since improved the prognosis to some extent. The ORR of MP for newly diagnosed is 40%, inconcluding 5% CR, but more than 5-year survival is less than 5% ~ 10%. As an anti-angiogenesis drugs, thalidomide was found to have a stronger role in inhibiting angiogenesis, by inhibiting the vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (BFGF) expression, thereby inhibiting MM angiogenesis and the growth of myeloma cells.In this paper, we compared MPT program (melphalan + prednisone + thalidomide, MPT group) with the MP program (melphalan + prednisone, MP group) in the treatment of multiple myeloma and the efficacy and toxicity. Methods and meterials: From September 2002 to December 2008, 47 patients with multiple myeloma were diagnosed in our department. MPT groups: 26 patients, melphalan 8mg/m2/d d1-4, prednisolone 60mg/m2 d1-4, or melphalan 4mg/m2/d d1-4, prednisolone 40mg/m2 d1-7, every 4 weeks for 1 cycle, thalidomide is given 100-200mg/d everyday. MP group: 21 cases, the dose of melphalan and prednisone are the same as MPT group.The efficacy is evaluated after 2-3 cycles of treatment.Results: MPT group of 26 patients, 12male, 14 female, 20 cases of newly diagnosed, 6 cases of progressive diease, the median age is 57.5 (36 ~ 78) years old. Peripheral hemoglobin concentration is 81.3±22.6g/l, 15 cases of bone destruction, bone marrow plasma cells rate is (34.8±24.7)%. Clinical types: 14 cases of IgG; 5 cases of IgA; 1 case of IgD; 4cases of light chain; 2cases of non-secretory type, mixed type in 1 case. 3cases ofПA , 18 cases ofШA, 3cases of IIIB. The overall response rate is (ORR = CR + PR + VGPR) 65.4%, inconcloding CR 1 cases (3.8%), VGPR 4 cases (15.4%), PR 12 cases (46.2%), of which two cases of progressive patients reach to treatment response. The median response time is 2 months. Hemoglobin and albumin after treatment were increased. 19 cases of adverse reactions (73%), including 9 cases of constipation (34%), 14cases of pancytopenia (27%), drowsiness in 4 patients (15%), limb numbness in three cases (12%), liver injury in 1 case ( 4%).4 cases of 3-4 grade toxicity. 7 prognostic factors show no significant relevant with ORR after single-factor analysis. The median PFS is 11 months(CI 5.3-10.9),2-year PFS is 66.18%.MP group a total of 21 cases, of which 10 cases of male, female 11 cases, 19 cases of newly diagnosed, progressive disease 2 cases, the median age is 61 (44 ~ 75) years old. Peripheral hemoglobin concentration is (82.8±24.8) g / L, 10 cases of bone destruction, bone marrow plasma cells rate is (46.0±33.1)%. Clinical types: 12 cases of IgG; 4 cases of IgA; 1 case of IgM; 4cases of light chain. 3cases ofШA , 1 case ofПB, 13cases ofШA, 4cases of IIIB. The overall response rate is (ORR = CR + PR + VGPR) 42.9%, inconcloding CR 0cases (0%), VGPR1cases (4.7%), PR8cases (38.1%), of which 0 cases of progressive disease patients reach to treatment response. The median response time is 3 months. Hemoglobin and albumin after treatment were not increased significantly. 9 cases of adverse reactions (43%), including 7 cases of pancytopenia (33%), drowsiness in 1 case (5%), constipation in 1 case (5%). 2 cases of 3-4 grade toxicity.Conclusions: The ORR of MPT group is significantly higher than that of MP group, with no statistical significance (P >0.05), the CR, VGPR and PR was no significant difference between the two groups (P > 0.05). The median response time is shorter in the MPT group than that in MP group. After treatment the average concentration of hemoglobin and albumin in MPT group are higher than those before the treatment (P <0.05), and compared with the MP group, the rise of hemoglobin and albumin concentration in the MPT group is significantly higher (P < 0.05). The incidence of adverse reactions of MPT group is higher than that of MP group (P <0.05), but the percentage of grade 3 and grande 4 toxicity is relative low, furthermore , after the reduction of thalidomide and surport treatment ,the patients can tolerant well. In the MPT group,The median PFS is 11 months,2-PFS is 66.18%. |
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