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)

Patients with multiple myeloma must be differentiated from those with monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). The plasma cell labeling index is helpful in differentiating MGUS or SMM from multiple myeloma (MM). No difference in survival was noted between patients given a single alkylating agent and those given a combination of alkylating agents. Alternating cycles of interferon alpha 2 and VBMCP (vincristine, BCNU, melphalan, cyclophosphamide, prednisone) produced a complete or near-complete response in 41% of patients. Allogeneic or syngeneic bone marrow transplantation has produced some benefit. Autologous bone marrow transplantation is potentially applicable to treat more patients. Major problems are eradication of myeloma cells from the bone marrow and removal of myeloma cells from autologous bone marrow. Purging of myeloma cells with monoclonal antibodies and chemotherapy may be helpful. Stem cells from autologous peripheral blood are being used for rescue after high-dose chemotherapy and total-body irradiation.
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PMID:Multiple myeloma. An update on diagnosis and management. 217 49

136 untreated multiple myeloma patients of stage II and III were collected in the study. 37/51 stage II patients had progressive disease and were treated with melphalan and prednisone (MP). 85 patients were of stage III and randomized into MP and vincristine, BCNU, adriamycin, melphalan and dexamethasone (VBAMDex) treatment groups. 55% of MP treated patients responded versus 75% of the VBAMDex group. Since the study has been activated only 16 months ago, no difference in survival could be observed.
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PMID:Melphalan and prednisone (MP) versus vincristine, BCNU, adriamycin, melphalan and dexamethasone (VBAMDex) therapy for multiple myeloma. Early results of a multicenter trial. The German Myeloma Treatment Group. 218 24

The results achieved in a series of 63 patients diagnosed of multiple myeloma in one Centre between February 1981 and December 1984 are reported. One patient was in stage IA, 27 in stage II (A, 24; B, 3), and the remaining 35 were in stage III (A, 22; B, 13). The initial therapy consisted of courses of vincristine, cyclophosphamide, melphalan and prednisone combination chemotherapy (VCMP) given every 4th week. Among the 56 patients who were evaluable, 28 (50%) showed objective response, 6 (10.7%) clinical improvement, and therapeutical failure was seen in 14, whereas 8 patients died during the first two months of treatment. The haematological tolerance to VCMP was acceptable, but neurotoxicity due to vincristine appeared in 17.8% of the cases. Thirty-two patients showing resistance to VCMP at any given moment received vincristine, BCNU, adriamycin and prednisone or dexamethasone (VBAP/D) as salvage therapy, only 5 responses (15.6%) being achieved. Only 5 patients are still alive and the median survival of the series is 23 months. Progression of the disease and infections were the major causes of death.
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PMID:[Treatment of multiple myeloma using vincristine, cyclophosphamide, melphalan and prednisone (VCMP). Long-term results in 63 patients]. 236

Seventy patients with progressive multiple myeloma received combination chemotherapy with cyclophosphamide and prednisolone (CP), BCNU, cyclophosphamide, procarbazine and prednisolone (BCPP), and MCNU, cyclophosphamide, melphalan and prednisolone (MCMP) as first line treatment. Total remission rate in patients treated with CP, BCPP, and MCMP was 76.2%, 86.1%, and 91%, and complete response rate 26.1%, 33.3% and 63.7%, respectively, 5-yr survival in the patients treated with CP and BCPP regimen was 51.9 +/- 11.1%, 39.7 +/- 8.9%, respectively, however, the difference was not significant, 1-yr survival in the patients treated with MCMP was 91 +/- 8.7%. It was postulated that long-term survival or cure can only be anticipated if the treatments giving high CR rates was developed. The study, though preliminary, supports the notion that MCMP therapy should be used as primary standard treatment for patients with multiple myeloma.
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PMID:[Combination chemotherapy of multiple myeloma]. 238 44

This report summarizes a broad experience in the treatment of patients with multiple myeloma resistant to standard chemotherapy. The VAD regimen has induced remissions in about 50% of relapsing patients but in only about 25% of previously unresponsive patients. In patients resistant to VAD, high-dose therapies with intravenous melphalan, a CBV combination (cyclophosphamide-BCNU-VP-16) or an EDAP regimen (VP-16 -platinum) produced responses in about 40% of patients. However, these treatments usually required autologous bone marrow or blood stem cell support and the median duration of control was only 6 months. With an even more intensive program using high-dose melphalan and total body irradiation supported by autologous bone marrow, all patients who survived the early treatment period responded for a median duration of about 1 year. Results indicated a dose-response effect of chemoradiotherapy on VAD-resistant myeloma with the potential that such intensive regimens will prolong disease-free survival time.
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PMID:Chemotherapy for resistant and relapsing multiple myeloma. 257 5

Ten patients with plasma cell leukaemia (PCL), out of 259 cases of multiple myeloma diagnosed in the Haematology Service of the University Hospital of Barcelona in the last 18 years, are presented. Of the 10 PCL cases, 5 were primary and 5 were secondary. Anaemia and thrombocytopenia, along with massive plasma cell infiltration of the bone marrow, were the most striking findings. Osteolytic lesions were present in 9 of the cases and liver involvement in two. Chemotherapy including vincristine and prednisone was administered to eight patients, associated to alkylating agents (melphalan and/or cyclophosphamide) in six of them. Four of these patients received also adriamycin and BCNU. Two objective responses were achieved, lasting for 10 and 3 months, the remaining six patients failed to respond. The median survival for all the PCL patients was less than one month (ranging between 0.2 and 14 months). None of the secondary PCL patients survived for 2 months after diagnosis. Infection (3 cases of septicaemia and 3 of pneumonia), renal failure (2 cases) and liver insufficiency (1 case) were the causes of death in the nine deceased patients. The therapeutic possibilities for this severe haemopathy are discussed.
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PMID:[Plasma cell leukemia. Study of 10 cases]. 265 43

17 patients with multiple myeloma (MM) received marrow transplants from their HLA-matched, MLC-negative sibling donors. 9 patients had progressive disease not responding to conventional treatments, while the other 8 patients were rated as responders. The most frequently used conditioning regimen consisted of total body irradiation and high-dose, multi-agent chemotherapy with cyclophosphamide plus either oral melphalan (5 cases) or BCNU (1 case) on both these drugs (7 cases). 12 patients were evaluable for response to BTM: 7 of them (6 responders and 1 with advanced refractory MM) entered complete remission, while 5 had a sustained decrease in tumor mass that ranged between 72% and 93%. 11 patients died of transplant-related causes, 1 of them with signs of progressive disease. The remaining 6 patients are alive and 5 of them maintain a complete remission status 4 to 67 (median 36) months after BMT. It is concluded that therapeutic benefits of transplantation in MM are still offset by the high mortality related to the procedure. A more accurate selection of patients who would most benefit from BMT and performing transplant at an earlier phase of the disease are warranted before major advances can be made in the cure of these patients.
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PMID:High-dose chemoradiotherapy and allogenic bone marrow transplantation in multiple myeloma. 269 91

Forty-four patients with progressive symptomatic multiple myeloma were treated with a protocol combining cyclophosphamide (10 mg/kg weekly), procarbazine (2 mg/kg daily), prednisolone (20 mg daily), and either BCNU (1 mg/kg weekly) (BCPP protocol) or MCNU (0.8-1 mg/kg) (MCPP protocol). Of these, 34 patients were treated with the former, and 10 patients with the latter. With BCPP protocol, 12 achieved a complete response, 11 evidenced a 75% response, and 7 displayed a 50% response. With MCPP protocol, on the other hand 2 achieved a complete response, 6 showed a 75% response, and 1 exhibited a 50% response. The median tumor halving time in both groups was 77 days and 57 days respectively. The 5-yr disease-free survival of patients treated with BCPP protocol was 62.0 +/- 10.8%. In MCPP group, 8 of 10 patients are alive with more than 49-87 weeks survival. Although myelotoxicity was moderate, other toxicities were moderate. Toxicity requiring dose modification and discontinuation of the scheduled therapy was observed.
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PMID:[Combination chemotherapy of multiple myeloma--BCNU.cyclophosphamide.procarbazine.prednisolone and MCNU.cyclophosphamide.procarbazine.prednisolone therapy]. 273 69

A total of 589 patients with previously untreated multiple myeloma were randomized to receive daily oral melphalan, pulse-dose intravenous (IV) melphalan, carmustine (BCNU), or lomustine (CCNU). All patients received an initial tapering course of prednisone (Pred). During week 22 (day 154), patients were randomized to receive or not to receive additional therapy with vincristine (VCR) (1 mg/m2) and prednisone (0.6 mg/kg/d for seven days) at 8-week intervals. The influence of VCR/Pred was determined in 302 patients who remained on study beyond 22 weeks after initial therapy. VCR/Pred converted a significant percentage of nonresponders to responders in patients treated with melphalan (55% v 19%, P = .002), but not in patients treated with a nitrosourea (48% v 23%, P = .06). Survival beyond week 22 was significantly longer following the addition of VCR/Pred in patients receiving melphalan (median, 35.3 months v 27.0 months; P = .003) but not in patients receiving BCNU or CCNU (median, 28.1 months v 26.2 months; P = .91). These differences were seen both for oral and IV melphalan. A trend for beneficial effect of VCR/Pred was definitely seen in the good-risk patients (P = .03) but only suggestive for poor-risk patients (P = .12). Following adjustment for VCR/Pred effects, there were no differences in the survival of patients receiving any of the four initial treatments.
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PMID:Vincristine and prednisone prolong the survival of patients receiving intravenous or oral melphalan for multiple myeloma: Cancer and Leukemia Group B experience. 304 38

Melphalan, ifosfamide, prednisolone, nitrosourea [1-(4-amino-2-methyl-5-pyrimidyl)-3-(2-chloroethyl)-3-nitrosourea hydrochloride, ACNU or 1, 3-bis (2-chloroethyl)-1-nitrosourea, BCNU] and vincristine (MIP-NV) were given in combination to 48 patients with multiple myeloma. The response rate was 57% in previously untreated patients, and 39% in previously treated patients. The median survival time of previously untreated patients in stage IA + IIA was 49 months, and that of patients in stage IIIA + B was 27 months. The median survival time of stage III patients depended significantly on the duration of remission. The duration of remission and survival time of patients with relief of pain and improvement in daily activity were significantly longer than those of patients without such effects. Age, sex, blood hemoglobin concentration and bone lesion were important prognostic factors. As for the side effects, leukopenia (less than 1,000/microliter) and thrombocytopenia (less than 5 X 10(4)/microliter) occurred in 10.4% and 2.1% of the patients, respectively. It was concluded that multiple drug combination therapy with MIP-NV (MIP-NV therapy) was effective for patients with multiple myeloma at all clinical stages, because it resulted in long survival with low toxicity.
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PMID:Combination chemotherapy for multiple myeloma with melphalan, ifosfamide, prednisolone, nitrosourea and vincristine. 316 36


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