Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018133 (graft-versus-host disease)
 18,032 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The crucial first step in management of multiple myeloma is to be certain regarding the diagnosis. Multiple myeloma must be distinguished from monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma. Therapy should be administered to patients with advanced and active myeloma involving anemia, osteolysis or renal failure. Chemotherapy with a single agent (melphalan) is the preferred initial treatment for overt, symptomatic multiple myeloma. Cytostatic drug combinations produce a higher response rate, but survival and remission during are the same compared with melphalan/prednisone therapy. However, in patients with renal failure and/or poor prognostic factors (advanced stage, elevated beta 2-microglobulin, high bone marrow plasma cell labeling index, high levels of C-reactive protein and lactate dehydrogenase and/or nodular pattern of bone marrow infiltration), combined treatment with adriamycin, vincristine and prednisone should be administered to prevent nephrotoxicity and attain a rapid paraprotein decrease. Alpha interferon treatment as maintenance seems to prolong the duration of the plateau state after response to chemotherapy, but apparently does not prolong survival. Allogeneic bone marrow transplantation involves significant early mortality (50%); the risk of graft versus host disease, infections and renal failure is a problem, and relapse is common. High dose chemotherapy followed by autologous bone marrow transplantation or peripheral blood stem cell reinfusion may prolong survival and free time to progression, but, to date, there are no indications of cure. This therapeutic procedure, therefore, should be considered for randomized trials for young patients with poor prognostic factors.
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PMID:[Diagnosis and therapy of multiple myeloma: current aspects]. 789 48

Patients with multiple myeloma must be distinguished from those with monoclonal gammopathy of undetermined significance and smoldering multiple myeloma. Therapy should be reserved for patients with active or symptomatic multiple myeloma. The pertinent literature on the diagnosis of multiple myeloma, prognostic factors, chemotherapy, and allogeneic bone marrow transplantation, as well as autologous peripheral blood or bone marrow stem cells for rescue, was reviewed. The two most powerful prognostic factors for multiple myeloma are the bone marrow plasma cell labeling index and the beta 2-microglobulin level. Chemotherapy is the preferred initial treatment for overt, symptomatic multiple myeloma. Combinations of alkylating agents produce a higher response rate, but the survival is the same as treatment with melphalan and prednisone. The combination of alpha 2-interferon with multiple alkylating agents produces a good response. alpha 2-Interferon prolongs the duration of the plateau state after a response to chemotherapy, but it apparently does not prolong survival. Allogeneic bone marrow transplantation is possible for only 5-10% of patients with multiple myeloma. Its advantage is that the graft contains no tumor cells that can subsequently produce a relapse. However, there is a significant early mortality, the risk of graft versus host disease is troublesome, and relapse of multiple myeloma is common. Autologous bone marrow transplantation is applicable for more patients because the age limit is higher and a matched donor is unnecessary. However, two major problems exist: (1) eradication of multiple myeloma from the patient may not occur even with large doses of chemotherapy and irradiation, and (2) infused autologous bone marrow or peripheral blood stem cells contaminated by myeloma cells or their precursors may be responsible for relapse.
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PMID:Newer approaches to the management of multiple myeloma. 824 81