Abstract
The aim of this study was to design a regimen for refractory multiple myeloma with minimum complications to achieve a reasonable response. Fifteen patients with active multiple myeloma after at least two lines of conventional treatment underwent therapy with our regimen for two cycles. Disease activity was evaluated after the last cycle. Another 15 patients with refractory multiple myelomas that had previously received only supportive therapy and pain management formed a historical control group. The follow-up period was 12 months for each study group. Of the patients receiving therapy, 6.7% achieved a complete response and 26.7% a partial response; overall response rate was 33.3%. Stable disease was achieved in 46.7% and 20% of the patients had progressive disease. There was no treatment related mortality. The hazard rate of death was 0.73 lower in the intervention group than in the historical control group. In the historical control group, 60% had progressive disease and 40% had stable disease; approximately 40% of patients died during the 12-month follow up. Also, the severity of pain was significantly reduced in the intervention group (P=0.033). Our chemotherapy regimen showed a reasonable response in end stage patients with multiple myeloma in terms of disease control, reducing bone pain and improving survival, in addition to reducing toxicity.
Highlights
Multiple myeloma (MM) is a neoplasm which is caused by proliferation of a clone of plasma cells, producing monoclonal immunoglobulin that invades the bone marrow and causes related symptoms such as bone deconstruction, hypocalcemia and renal insufficiency.[1]
The treatment regimen consisted of cyclophosphamide 1000 mg/m2 for one day and 100 mg/m2 of etoposide for three days for a total dose of 300 mg/m2 in each cycle
Cyclophosphamide was infused through 500 cc of 0.9% normal saline solution in 2 h
Summary
Multiple myeloma (MM) is a neoplasm which is caused by proliferation of a clone of plasma cells, producing monoclonal immunoglobulin that invades the bone marrow and causes related symptoms such as bone deconstruction, hypocalcemia and renal insufficiency.[1] Its inci-. Control group dence ratio is 4-5 persons per 100,000. It makes Conflict of interests: the authors report no potenup 1% of all cancers and slightly more than 10% tial conflict of interest. The introduction of the melphalan-prednisolone regimen in Received for publication: 11 April 2012.
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