The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Effect of Cyclophosphamide and Prednisone as a First-line Treatment for Non-transplant Candidates with Multiple Myeloma

다발골수종의 Cyclophosphamide 및 Prednisone 복합화학요법의 효과

  • You, Mi-Ra (Department of Internal Medicine, Hemato-oncology College of Medicine, Chosun University) ;
  • Lim, Hyun-Jong (Department of Internal Medicine, Hemato-oncology College of Medicine, Chosun University) ;
  • Lee, Hee-Jeong (Department of Internal Medicine, Hemato-oncology College of Medicine, Chosun University) ;
  • Kim, Hyung-Ho (Department of Internal Medicine, Hemato-oncology College of Medicine, Chosun University) ;
  • Moon, Woo-Ram (Department of Internal Medicine, Hemato-oncology College of Medicine, Chosun University) ;
  • Chung, Choon-Hae (Department of Internal Medicine, Hemato-oncology College of Medicine, Chosun University) ;
  • Park, Chi-Young (Department of Internal Medicine, Hemato-oncology College of Medicine, Chosun University) ;
  • Park, Sang-Gon (Department of Internal Medicine, Hemato-oncology College of Medicine, Chosun University)
  • 유미라 (조선대학교 의과대학 내과학교실 종양혈액내과) ;
  • 임현종 (조선대학교 의과대학 내과학교실 종양혈액내과) ;
  • 이희정 (조선대학교 의과대학 내과학교실 종양혈액내과) ;
  • 김형호 (조선대학교 의과대학 내과학교실 종양혈액내과) ;
  • 문우람 (조선대학교 의과대학 내과학교실 종양혈액내과) ;
  • 정춘해 (조선대학교 의과대학 내과학교실 종양혈액내과) ;
  • 박치영 (조선대학교 의과대학 내과학교실 종양혈액내과) ;
  • 박상곤 (조선대학교 의과대학 내과학교실 종양혈액내과)
  • Received : 2012.08.20
  • Accepted : 2012.11.06
  • Published : 2013.05.01
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Abstract

Background/Aims: For many years, conventional treatment for multiple myeloma (MM) not ineligible for high-dose therapy has been the combination of oral melphalan and prednisone (MP). However, melphalan-based regimens are associated with numerous complications. Another alkylating agent, cyclophosphamide, has similar effects on MM and is associated with fewer reports of complications. Therefore, cyclophosphamide-based regimens have usually been used as salvage therapy in patients with refractory or relapsed MM, despite the development of newer drugs. The purpose of this report was to evaluate the efficacy and tolerability of cyclophosphamide and prednisone as a first-line therapy for MM. Methods: For the period January 2002 to June 2012, we retrospectively analyzed 29 patients newly diagnosed with MM who underwent a treatment regimen consisting of intravenous cyclophosphamide (1,000 mg/kg) for 1 day and prednisone (100 mg) for 4 days. Results: The rate of response to this regimen was 31.1 percent. The median progression-free survival (PFS) was 5.5 months and the median overall survival (OS) was 47.3 months. The regimen was well tolerated. Adverse effects of grades above III were as follows: anemia in seven patients (24.1%), neutropenia in five patients (17.2%), and thrombocytopenia in two patients (6.8%). These adverse effects were easily adjusted. No one developed a secondary malignancy or hemorrhagic cystitis. Conclusions: Although PFS was less than for the MP regimen, median OS was better than for the MP regimen. Furthermore, the cyclophosphamide-prednisone regimen was well tolerated, and the adverse effects that did occur were easily adjusted. The cyclophosphamide-prednisone combination regimen may represent an effective and well tolerated first-line therapy for non-transplant candidates with MM.

본 연구는 3회 이하로 투여된 환자가 13명으로 총 29명 중 상대적으로 많은 환자에서 빨리 중단되었고 후향적 분석으로 의무기록에 근거하여 기록하여 약제의 정확한 치료 효과 및 부작용을 판별하는 점은 쉽지 않았다는 한계점은 있다. 그러나 다발골수종은 고령에서 발생하고 진단 당시 합병증이 있는 경우가 많으며 연령이나 활동도 또는 합병증, 여러 경제적 상황들로 조혈모세포 이식을 시행하기가 불가능한 경우가 많다. 현재 많은 표적 치료제가 임상에 적용되고는 있으나 많은 제약점으로 여전이 과거의 알킬화 제제를 이용한 항암화학요법이 현재도 유용하게 사용되고 있는 현재 임상 상황에서 melphalan과 prednisone 복합요법보다 부작용에 이 적고 정주를 통해 체내 일정 농도의 유지가 가능하며 투여 요법이 간편한, 그리고 보다 중앙 생존 기간의 연장을 보일 수 있는 cyclophosphamide, prednisone 복합요법을 전신상태가 좋지 못한 환자에서 다발성 골수종의 초기 치료로서 사용하는 것도 좋은 치료 전략으로 보인다.

Keywords

References

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