Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0026764 (multiple myeloma)
 36,148 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Prospective studies were carried out on the effectiveness of various treatment methods in 208 patients with plasmocytic myeloma. In 102 patients induction therapy was based exclusively on melphalan, in 106 cases polychemotherapy was used including vincristine, melphalan, carmustine, cyclophosphamide and prednisone. The differences in the per cent of patients with good response to treatment and in the survival time after treatment beginning were statistically not significant between these groups which suggests that polychemotherapy begun from the diagnosis of the disease is justified in patients with large mass of the neoplasm and poor prognostic factors. In 45 patients chemotherapy was supported by administration of immunomodulatory agents, including calf thymus extract in 25 cases, levamisole in 18 and interferon in 2. It was observed that maintenance of remission with chemotherapy and with immunomodulatory agents calf thymus extract or levamisole prolonged the survival of the patients. In cases of leucopenia the use of calf thymus extract facilitated chemotherapy by stimulation of myelopoiesis.
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PMID:[Chemotherapy and immunomodulating treatment of patients with multiple myeloma]. 182 65

We have successfully treated multiple myeloma of IgD (lambda) type [IgD (lambda) -MM] by natural alpha-interferon (alpha-IFN) single therapy. A 45 year-old man was admitted to Tokyo Medical College Hospital because of general fatigue in August, 1989. Immunoelectrophoresis, bone marrow biopsy and systemic bone survey revealed IgD (lambda) -MM with Bence Jones (BJ) proteinuria and slightly osteolytic lesions. We started treating him with natural alpha-IFN single therapy. Three months later, serum IgD markedly decreased and BJ proteinuria disappeared. Bone marrow, which had been packed with myeloma cells at the admission, was almost replaced by normal hematopoietic cells. In April 1990, he is still free of disease with only alpha-IFN single therapy. This result might suggest that alpha-IFN single therapy is effective for IgD-MM.
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PMID:[The successful use of natural alpha-interferon single therapy in multiple myeloma of IgD (lambda)-type]. 190 71

Twenty patients (median age 57 years) with high tumor mass myeloma in first remission after conventional chemotherapy received a two-phase treatment: autologous bone marrow transplantation (ABMT) using a preparative regimen of high dose melphalan plus total body irradiation followed by maintenance treatment with recombinant alpha interferon. Before ABMT all patients were in partial remission, while after ABMT 10 (50%) achieved complete remission, and 10 remained in partial remission (with a 90% decrease in measurable paraprotein in 7/10). With a median follow-up of 19.8 months (12.2-33.5) after diagnosis and 13 months (4-25) after ABMT, the Kaplan-Meier 2-year post-ABMT probability of progression-free survival was 85% (95% CI = 58.7-95.8%). None of the 10 patients in complete remission has relapsed. No toxic death occurred. Alpha interferon was introduced early after ABMT (2.7 months) and was well tolerated. This strategy may represent an advance in the management of aggressive myeloma.
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PMID:Maintenance treatment with recombinant alpha interferon after autologous bone marrow transplantation for aggressive myeloma in first remission after conventional induction chemotherapy. 193 53

The treatment of multiple myeloma is multidisciplinary and requires attention not only to the primary disease itself but to its secondary manifestations. Melphalan remains the single most effective oral chemotherapeutic drug used to treat multiple myeloma. A major problem with the oral administration of the drug is its variable bioavailability. The presence of an L-phenylalanine moiety in the structure of melphalan makes it likely that gastrointestinal absorption occurs through the normal amino acid transport mechanisms and that the presence of food influences the drug's uptake. Another factor that complicates the bioavailability of this agent is the fact that melphalan undergoes spontaneous hydrolysis at physiologic pH. One of the controversies in myeloma therapy is the continuing debate over the possible superiority of complex, multiagent chemotherapy regimens compared with single melphalan and prednisone or cyclophosphamide and prednisone. It does appear that response frequencies are considerably greater with combination chemotherapy than with standard oral melphalan and prednisone treatment. It is probable that both approaches--single-agent chemotherapy with melphalan and prednisone versus combination chemotherapy--can play a role in remission induction therapy. It may be appropriate to treat the patient with a low tumor burden with melphalan and prednisone and treat more aggressive myeloma patients with triple alkylator therapy or other combinations of chemotherapy agents. The most promising activity of interferon alfa-2b (rIFN alpha 2b) in induction of myeloma remission appears to occur when rIFN alpha 2b is combined with multiple alkylating agents. Analysis of clinical trials suggests that sequential use of rIFN alpha 2b with cytotoxic therapy may be more active than when IFN alpha 2b is given concomitantly with cytotoxic therapy. It may be most plausible to use rIFN alpha 2b in maintenance of remission of myeloma. In the laboratory, interferons have the capacity to modulate oncogene expression and to decrease both in vitro colony formation and the labeling index of myeloma cells. Further, it has been shown that interferon can reduce the capacity for self-renewal in myeloma-forming cells. The following concepts will be discussed: 1. There is promising evidence that rIFN alpha 2b may improve the frequency and quality of remission in multiple myeloma when administered in an alternating schedule. There is some evidence that rIFN alpha 2b, when combined with cytotoxic therapy and given concomitantly, may be less active.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:A review of the clinical studies of alpha-interferon in the management of multiple myeloma. 194 25

Interferon has been evaluated in many settings for the treatment of multiple myeloma. As a single agent in refractory disease, interferon in partially purified preparations and, more recently, recombinant alpha-interferon (rIFN) has demonstrated response rates of 10% to 20%. Because of its demonstrated activity as a single agent, various combinations of rIFN with chemotherapy have been evaluated. The Italian Myeloma Study Group has found that maintenance therapy with rIFN alpha 2b prolongs the time to relapse following a year of standard chemotherapy. The Cancer and Acute Leukemia Group B has evaluated a regimen that combines rIFN alpha 2b with simultaneous melphalan and prednisone. In a third approach, the Eastern Cooperative Oncology Group has developed a regimen consisting of alternating cycles of VBMCP (vincristine, carmustine, melphalan, cyclophosphamide, and prednisone) chemotherapy with rIFN alpha 2b. This regimen yields an 80% objective response rate, including 30% complete responses defined by disappearance of M-protein from serum and urine and complete morphologic normalization of the bone marrow. On preliminary analysis, the response duration and median survival were both approximately 1 year longer than generally observed in patients with multiple myeloma on standard regimens. Hematologic toxicity, although more severe than that observed previously with VBMCP alone, was not associated with increased infections or bleeding. To substantiate the observation of apparent increased activity of VBMCP + rIFN alpha 2b, the Eastern Cooperative Oncology Group is currently conducting a randomized comparison of this regimen with treatment using VBMCP alone.
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PMID:Strategies for combining interferon with chemotherapy for the treatment of multiple myeloma. 194 26

This preliminary report focuses on the therapeutic role of interferon in a large randomized trial evaluating combination chemotherapy induction and interferon maintenance, as compared with no maintenance therapy, in patients with newly diagnosed multiple myeloma. The trial also included an evaluation of the combination of interferon and dexamethasone therapy for patients who failed to respond to induction chemotherapy or who had achieved only a partial remission. Case accrual is completed for remission induction with 505 eligible patients registered on study, but is still open for additional maintenance registrations. As of January 1991, 161 patients have been randomized to interferon versus observation, but the therapeutic results of this aspect of the study remain coded. Toxicity of interferon maintenance was generally of a mild to moderate degree, and less severe than that of the interferon/dexamethasone combination, which was due to the addition of steroid side effects. Among 41 patients who failed to achieve remission with chemotherapy, 13 (32%) achieved at least a partial remission with interferon/dexamethasone, and only five others (12%) have had progressive disease. Of 12 partial responders on induction chemotherapy, five (42%) achieved remission (75% tumor regression) with interferon/dexamethasone. To date, more than 65% of patients receiving interferon/dexamethasone remain alive, suggesting that this regimen will be useful for patients who fail to achieve remission with induction chemotherapy.
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PMID:alpha-Interferon for remission maintenance: preliminary report on the Southwest Oncology Group Study. 194 27

Over the course of a 2-year period (September 1987 to September 1989) a total of 432 patients with multiple myeloma were registered in a study comprising 39 Swedish and one Italian clinics. Six of these were university hospitals, the others were county (community) hospitals. A total of 308 patients fulfilled the eligibility criteria of the protocol, and were started on traditional intermittent melphalan-prednisone therapy. Response, defined as a reduction in the concentration of the M-component in serum or urine, was observed in 58% of patients, and a clearly defined plateau phase was noted in 38% of the cases. Of the patients who achieved a plateau phase, 120 individuals (with a median age of 71 years) were at this point randomized between no further therapy and continuous interferon-alfa-2b at a dose of 5 x 10(6) IU subcutaneously three times per week. At relapse the interferon therapy was discontinued, and melphalan-prednisone restarted. Only preliminary data and interim results are at this point available. The final evaluation of the study will be performed after June 1, 1991. The treatment arms are comparable with regard to age, stage according to Durie-Salmon, renal function, immunoglobulin class, and type of response to the cytostatic therapy (rapid versus slow). A median number of six courses of melphalan-prednisone were administered before randomization. For those patients in whom pretreatment serum beta-2-microglobulin was analyzed, no difference in the median values between the treatment arms was found. The median observation time from randomization is 20 months. At the time of this analysis, 85 had relapsed: 33 of 59 (56%) in the interferon arm, and 52 of 61 (85%) in the no therapy arm. An interim analysis of the duration of the plateau phase (from the time of randomization) was performed in October 1990, showing a highly significant difference between the two treatment arms (P less than .001). The median duration of plateau was 59 weeks in the interferon arm, and 26 weeks in the no therapy arm. To date there have been 34 deaths, 13 in the interferon arm and 21 in the no therapy arm. All patients in the no therapy arm died from multiple myeloma (n = 19), or from another cause, but with the myeloma in an uncontrolled, progressive state (n = 2). In the interferon arm, only 10 patients died from progressive myeloma, and four of these either did not start interferon therapy at all (n = 1), or discontinued therapy early (n = 3).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Interferon therapy during the plateau phase of multiple myeloma: an update of a Swedish multicenter study. 194 28

A new case of IgE myeloma is described. A 77-year-old woman presented with bone pain and fatigue. Serum protein analysis revealed a paraprotein of the IgE kappa type; bone marrow aspirate and immunofluorescence confirmed the diagnosis; ultrastructural examination showed immature plasma cells. Treatment with prednisone, melphalan, cyclophosphamide and interferon alfa did not produce any improvement and the patient died 5 months after diagnosis. The patient's clinical and laboratory data are compared with those of IgE myeloma cases reported in the literature.
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PMID:A new case of IgE myeloma. 201 30

Serum beta 2-microglobulin (beta 2m) levels were followed in eight patients with multiple myeloma who were treated with leucocyte alpha interferon (alpha IFN) 6 x 10(6) IU daily for 1-2 weeks before chemotherapy. Serial measurements of serum beta 2m were carried out regularly during the first week on alpha IFN. A rise in beta 2m was observed in all patients. with maximum increments ranging from 29% to 185% (mean 109%). The increase in beta 2m was most marked in patients with elevated pretreatment levels of serum beta 2m and creatinine. In six patients the peak value was reached between the third and the fifth day, after which the levels decreased. In two patients serum beta 2m remained elevated for 3 and 4 months, respectively. A marked increase in serum beta 2m can be induced by alpha IFN in myeloma, which should be taken into consideration when using beta 2m for the assessment of tumour response during alpha IFN therapy.
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PMID:Alpha interferon raises serum beta-2-microglobulin in patients with multiple myeloma. 201 58

Among 68 patients with resistant multiple myeloma, alpha-interferon was combined with either the VAD regimen for those in relapse, or high-dose dexamethasone for those who had never responded. Neither the response rate nor the survival time improved in comparison with similar treatments without interferon. Results affirmed no benefit with added interferon in myeloma patients with advanced disease resistant to standard therapies. Certain prognostic features for low likelihood of response and for short survival identified patients who should be considered early for intensive therapies that require bone marrow or blood stem cell support.
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PMID:Alpha-interferon combination therapy of resistant myeloma. 203 4


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