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约30～50％的骨髓瘤患者对第一线治疗无效称为顽固性骨髓瘤。最初治疗有效的患者如未死于其它病因,肿瘤也会复发,因此需寻求最佳治疗。本文回顾顽固性骨髓瘤的治疗效果及作者治疗的经验。顽固性骨髓瘤有2种;①最初治疗无效者;②继发性无效或复发者。最常用的疗效判定标准即疗效指数是检测血清和/或尿M蛋白浓度。现有两种疗效标准供采用,即SWOG(西南肿瘤组)和国立癌症研究所的标准,它们的主要差异为前者至少需要减少76％M蛋白的合成,而后者要求减少大于50％的M蛋白浓度。作者及多数研究使用后一标准。为便于分析,治疗随机分5组:①标准剂量一种细胞毒制剂和糖皮质激素;②联合化疗;③干扰素;④全身性放疗;⑤大剂量化疗部分加骨髓移植。
About 30 to 50% of patients with myeloma ineffective first-line treatment is called refractory myeloma. The initial treatment of patients who do not die of other causes, the tumor will relapse, it is necessary to find the best treatment. This article reviews the treatment of refractory myeloma and the author’s experience of treatment. There are two kinds of intractable myeloma; ① initial treatment ineffective; ② secondary ineffective or relapse. The most commonly used curative effect criterion, the curative index, is the serum and / or urine M protein concentration. There are two existing efficacy standards available, the SWOG (Southwest Oncology Group) and the National Cancer Institute standards, whose main difference is that the former requires at least a 76% reduction in M protein synthesis while the latter requires a reduction in M protein greater than 50% concentration. The authors and most studies use the latter standard. For ease of analysis, treatment was randomly divided into 5 groups: ① standard dose of a cytotoxic agent and glucocorticoid; ② combined chemotherapy; ③ interferon; ④ systemic radiotherapy; ⑤ high-dose chemotherapy plus bone marrow transplantation.