Assuntos
Crupe/diagnóstico , Hematoma/diagnóstico , Laringe/lesões , Ferimentos não Penetrantes/diagnóstico , Algoritmos , Criança , Erros de Diagnóstico , Hematoma/terapia , Humanos , Laringoscopia , Masculino , Sons Respiratórios , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/terapiaRESUMO
Because the presence of IgG paraprotein in the blood is clear cut, it makes IgG myeloma a more circumscribed disease than myeloma as a whole in which to study treatment efficacy, particularly relating to complete remission (CR). Between May 1989 and December 1997, 177 consecutive patients with IgG myeloma who were <75 years old were seen, of whom 153 entered a sequential therapy (ST) programme of initial courses of C-VAMP infusional chemotherapy (IC), high-dose treatment (with or without stem cell rescue) (119 patients) and maintenance interferon (87 patients). 74/153 (48.4%) patients entered CR. Median overall survival (OS) and event-free survival (EFS) were 4.9 and 2.1 years, respectively. Multivariate analysis at presentation showed OS was significantly prolonged for beta2M <2.7 mg/l and age Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
, Imunoglobulina G/imunologia
, Mieloma Múltiplo/tratamento farmacológico
, Adulto
, Idoso
, Ciclofosfamida/administração & dosagem
, Intervalo Livre de Doença
, Doxorrubicina/administração & dosagem
, Feminino
, Humanos
, Imunoglobulina A/imunologia
, Interferons/uso terapêutico
, Masculino
, Metilprednisolona/administração & dosagem
, Pessoa de Meia-Idade
, Mieloma Múltiplo/imunologia
, Prognóstico
, Recidiva
, Vincristina/administração & dosagem
RESUMO
The established treatment for multiple myeloma (MM) comprises induction with infusional chemotherapy, high dose chemotherapy (HDC) and autologous transplantation followed by maintenance interferon. On relapse, patients (pts) are reconsidered for this however some are unsuitable and in this situation the therapeutic options are limited. Between June 1995 and May 1997, 14 pts with previously treated relapsed or refractory MM were recruited. Using a prospective database, the tolerability and efficacy of chronic low dose oral idarubicin was evaluated. The median age of pts was 63 years. All had received previous anthracycline in the form of infusional cVAMP chemotherapy. 11/14 had received previous HDC. Median time from diagnosis to commencing idarubicin was 77 months. 10 mg idarubicin was administered 3 times/week for 3 weeks of a 5 week cycle. The maximum number of courses was 6. Three pts completed 6 courses, 5 pts 3 courses, 2 pts 2 courses and 4 pts 1 course. The reasons for stopping treatment were death due to progressive disease (PD) in 7 pts, persistent thrombocytopenia in 2 pts, PD in 1 pt and 1 pt suffered a cerebral infarction not considered to be related to the idarubicin therapy. Two pts showed evidence of response, neither amounting to a partial response. One had stabilisation of paraprotein with a reduction in bone marrow infiltration (47% to 7% plasma cells), the other had a reduction in bone marrow infiltration after 3 course but an increase after 6 courses. In total forty-one courses of treatment were administered. Grade 3/4 haematological toxicities were noted in a minor fraction of cases and were as follows: anaemia 6/41, neutropenia 10/41 and thrombocytopenia 11/41. Our data therefore shows a minor response in 2/14 (14%) of heavily pretreated patients with MM, without evidence of severe toxicity. It provides the rationale for using oral idarubicin as either single agent or in combination therapy for patients earlier on in their disease course especially if they are unsuitable for standard therapy.
Assuntos
Antibióticos Antineoplásicos/uso terapêutico , Idarubicina/uso terapêutico , Mieloma Múltiplo/tratamento farmacológico , Adulto , Idoso , Antibióticos Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ciclofosfamida/administração & dosagem , Progressão da Doença , Doxorrubicina/administração & dosagem , Resistencia a Medicamentos Antineoplásicos , Humanos , Idarubicina/efeitos adversos , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Indução de Remissão , Terapia de Salvação , Trombocitopenia/induzido quimicamente , Falha de Tratamento , Vincristina/administração & dosagemRESUMO
We describe a single centre experience of 33 patients allografted for multiple myeloma, of which 28 received matched sibling marrow, one haploidentical family donor marrow and four matched but unrelated donor marrow. Median follow-up after transplant is 27 months, and 13 patients are currently alive. One out of four patients with an unrelated donor survives and 12 out of 28 (42.8%) with matched sibling donors. Four patients were unevaluable because of early death (Assuntos
Transplante de Medula Óssea
, Mieloma Múltiplo/terapia
, Condicionamento Pré-Transplante
, Adulto
, Transplante de Medula Óssea/efeitos adversos
, Bussulfano/uso terapêutico
, Terapia Combinada
, Ciclofosfamida/uso terapêutico
, Feminino
, Doença Enxerto-Hospedeiro/etiologia
, Humanos
, Masculino
, Melfalan/uso terapêutico
, Pessoa de Meia-Idade
, Prognóstico
, Transplante Homólogo
, Irradiação Corporal Total