Second and third responses to the same induction regimen in relapsing patients with multiple myeloma

Article Abstract:

Improvements in chemotherapy have, in recent decades, increased the survival time for patients with multiple myeloma. Although long-term survival is possible for patients with multiple myeloma, the disease is never considered cured, since the threat of relapse never entirely disappears. Questions have been raised concerning the use of maintenance chemotherapy for patients with multiple myeloma. Maintenance chemotherapy is chemotherapy that is given after a complete response has been induced to lengthen the period of remission. In patients with multiple myeloma it is not clear that maintenance therapy is effective. However, the agents used in therapy contribute to an increased rate of leukemia among long-term survivors. A study was conducted to evaluate a chemotherapeutic protocol in which the therapy is halted when a remission is achieved. In addition to reducing the patients' overall risk of leukemia, this protocol can improve the quality of life for the myeloma patients, as well. A total of 155 patients were treated; 82 percent had better than 50 percent reduction in disease. The median duration of the response achieved was 22 months. In addition, the same treatment regimen was effective when used a second time in the relapsed patients. This finding suggests that the omission of maintenance therapy may be made without undue risk to the patients' survival. Twenty-six of 38 patients responded to the second treatment, a response rate less than that for the initial therapy. At 11 months, the median response duration was also shorter than it was to the first induction chemotherapy. It was possible to again achieve a response in 7 of 16 patients who received the chemotherapeutic regimen for a third time. This time, the median response duration was 3.5 months. The results of this study indicate that multiple patients may omit maintenance chemotherapy without adversely affecting their chances for survival. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Prognosis, Multiple myeloma

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Chemotherapy for invasive thymoma: a 13-year experience

Article Abstract:

Cancers of the thymus gland are relatively uncommon. These malignant thymomas are generally treated with surgery and radiation. However, if the cancer has already begun to invade the surrounding tissues, chemotherapy may be the only solution. Unfortunately, studies of single chemotherapeutic drugs in the treatment of advanced thymoma have been disappointing. Cisplatin is the only drug which has shown any effectiveness by itself, although some partial responses to doxorubicin and prednisone have been reported. Over a 13-year period, a total of 37 patients were treated for advanced thymoma with a combination of four chemotherapeutic drugs: cisplatin, doxorubicin, vincristine, and cyclophosphamide. (This combination is sometimes referred to as ADOC.) Analysis of the results of these cases revealed the combination to be effective against thymoma. Forty-three percent of the patients achieved a complete response, and 91.8 percent achieved either a complete or a partial response. The median survival time for all the patients was 15 months, and the survival of individual patients ranged from five to over 96 months. Over half of the patients who achieved complete remissions are still alive, and therefore it is not yet possible to evaluate the median survival for this group. The results obtained with the ADOC chemotherapeutic regimen are superior to the reported successes achieved with other treatment methods. Therefore, it may be appropriate to include the ADOC therapy as adjuvant therapy for patients undergoing surgery for thymoma. Patients undergoing surgical treatment may benefit from either adjuvant therapy, in which the ADOC treatment is given after surgery, or neoadjuvant chemotherapy, in which the ADOC treatment is administered in preparation for surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Thymoma

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