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<p><b>OBJECTIVE</b>To observe treatment response, survival, safety and the improvement of ECOG in patients with refractory multiple myeloma (MM) with serious heart failure after the administration of continuous low-dose of cyclophosphamide combined with prednisone (CP).</p><p><b>METHODS</b>From January 2005 to September 2013, a total of 75 patients were treated by metronomic chemotherapy with continuous low-dose cyclophosphamide (50 mg/d) and prednisone (15 mg/d).</p><p><b>RESULTS</b>Among the 75 patients, 2 were lost for follow-up. In the 73 available patients, the overall response was 64.4%, including 2 patients (2.7%) with complete remission (CR), 4 cases (5.5%) very good partial remission (VGPR), and 24 patients (32.9%) partial remission (PR). The median survival was 12 months (1-70 months) with a median onset time of 90 days (16-120) and a median progressive freedom survival of 12 months (1-60). The level of B-type natriuretic peptide in responders declined significantly, as compared to no responders [(336.6 ± 30.3) ng/L vs (906.4 ± 104.8) ng/L, P<0.01]. Common adverse events were as follows: 32 (43.8%) cases of bone marrow suppression, 26 (35.6%) cases of infection, 8 cases of dizzy as well as sleepiness (11.0%), 7(9.6%) cases of Cushing syndrome, 4 (5.5%) cases of secondary diabetes mellitus, and 3 (4.1%) cases of edema respectively.</p><p><b>CONCLUSION</b>The metronomic chemotherapy of cyclophosphamide combined with prednisone had satisfactory impact on the treatment outcome, including the improvement of cardiac functions and physical capacities, better survival and safety in refractory MM with serious heart failure. It provides a novel regimen for such patients.</p>
Subject(s)
Humans , Antineoplastic Combined Chemotherapy Protocols , Clinical Protocols , Cyclophosphamide , Heart Failure , Multiple Myeloma , Prednisone , Remission Induction , Treatment OutcomeABSTRACT
Objective To evaluate the efficacy andtolerability of continuous low-dose cyclophosphamide and prednisone treatment of relapsed and refractory multiple myeloma. Methods84 relapsed and refractory multiple myeloma patients were enrolled, including 46 males and 38 females, the assess patients of 81 cases with average age of 69.7 (45-91)years. They were treated continuous with oral cyclophosphamide (50 mg/d) and prednisone (15 mg/d) and monthly follow-up.ResultsAverage follow-up time were 23.5(1-71)months.The assessed patients were 81 cases,with 52 cases (64.2 ％) responded.There were 2 cases(2.5 ％)CR,21 cases(25.9 ％) of PR,29 cases(35.8 ％)MR,19 cases(23.5 ％)NC and 10 cases (12.3 ％)PD.The median time to response was 2 months.In the patients who responded to the treatment,the median progression-free survival(PFS)and overall survival (OS) were 18(95 ％CI 12.8-23.2),29(95 ％CI 24.1-33.9)months.In the non-responding patients,the PFS and OS were 4(95 ％ CI 2.2-5.8) and 6(95 ％ CI 4.9-7.1)months.Two groups were statistically significant(P＜0.05).The most common toxicities included fatigue,nausea, neutropenia, hyperglycemia and lung infection. No patient withdrew from the study because of toxicity. Conclusions Continuous low-dose cyclophosphamide combined prednisone is a treatment options for relapsed and refractory MM patients.
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Objective To evaluate the efficacy and side effects of standard-dose of dexamethasone and low-dose dexamethasone combined with thalidomide in treatment of multiple myeloma. Methods Thirtynine patients with multiple myeloma were randomly divided into 2 groups, who were treated with chemotherapy of thalidomide (200 mg/d) plus dexamethasone (40 mg d1-46728 days in standard-dose group and 20 mg dl-4d/28 days in low-dose group), for a total of 4 courses. The efficacy, survival time and adverse events were compared between the two groups. Results Complete remission rate, partial remission rate and overall response rate of the standard-dose group were 26.3 %, 35 % and 75 %, respectively; and those of the low-dose group were 15.8% , 36.8 % and 68.4 %, respectively. No statistical difference between the two groups (P >0.05 ) was observed. Lung infections, blood pressure elevation, blood glucose elevation, shingles and other adverse reactions in the standard-dose group were statistically higher than those in the low-dose group (P <0.05). Conclusion Efficacy on multiple myeloma of standard-dose and low-dose dexamethasone are similar, but adverse reactions are significantly increased.
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Objective To study the effect of thalidomide and arsenic trioxide on the proliferation and apoptosis effect in human myelodysplastic syndrome cell line MUTZ-1 and explore its possible mechanism.Methods MUTZ-1 cells were cultured with different concentration of thalidomide alone, arsenic trioxide alone, and thalidomide plus arsenic trioxide for 48 h. The cell proliferation was analyzed by CCK-8 test, and cell apoptosis was analyzed by flow cytometry. The expression of Bmi-1 was analyzed by semi-quantitative RT-PCR. Results Thalidomide alone had no significant inhibition on growth of MUTZ-1 cells (P >0.05).Arsenic trioxide alone had obviously inhibited the cell proliferation (P 0.05), and the combined group with the drug also increased the concentration of expression (P 0.05), the combined group Bmi-1 inhibition was significantly higher than arsenic trioxide, thalidomide in a separate drug group (CDI <0.7).Conclusion Thalidomide group had no significant growth inhibition. Arsenic trioxide on MUTZ-1 cells significantly inhibited the growth and increased in the combined group significantly.
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Inducible nitric oxide synthase(iNOS) and cyclooxygenase-2(COX-2) are nitration and oxidation related enzymes, and their correlations with tumors have been drawing more and more attention.There are 2 different viewpoints on the correlation between the 2 enzymes and hematological malignances,and their functioning mechanisms are still unclear.The selective inhibitors of NOS,COX,or the both may provide a new approach for the treatment of hematological malignancies.
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0. 05). Conclusion: The HCAPl can be expressed in both normal peripheral white blood cells and the leukemic cells, and there is no difference in the protein levels between them.