骨髄腫の化学療法に関する臨床的研究 第2編 Melphalan-Ifosfamide-Prednisolone交替併用療法における治療効果,予後因子,および副作用の検討

This report consists of an analysis of 47 patients with multiple myeloma registered between October, 1975, and December, 1980. All of them received Prednisolone together with sequential Melphalan and Ifosfamide (MIP). Clinical studies of the response rates and prognostic factors were conducted and side effects and complications in the treatment of MIP were discussed. The results are summarized as follows: 1. The response rates to MIP therapy as shown by marked diminishment of plasmacytoma and decrease of bone marrow plasmacytosis below 10 per cent were slightly lower than in M, MP, or I therapy. In MIP therapy, the frequency of over 50% reduction of the pretreatment value of M-protein level was 59.6% and the frequency of marked improvement in symptomatic disability was 52.9%. In conclusion, MIP therapy seemed to be better overall in comparison to M, MP, and I. 2. The 50% survival time in 47 patients treated with MIP followed from the initiation of treatment was 19 months. 3. In MIP therapy, the response rate (shown by the reduction of M-protein level) was paradoxically higher in all clinical parameters in the advanced stage group than in the early and intermittent stages. This study made clear the relationship between the survival time and patients characteristics. Of clinical parameters, (1) age, (2) stage IV in the clinical staging of Durie and Salmon, (3) hypercalcemia, (4) extensive bone lytic lesions, and (5) type IV in the patho-morphological stage of Brucher correlated with progressive life span shortage. 5. Patients who responded rapidly (i.e. within 5 weeks) had a longer duration of remission and longer survival than those who responded slowly (6-16 weeks). 6. In stage III, patients who received MIP had a higher response rate and longer survival than those who received M+MP. 7. Side effects and complications reported during MIP treatment were as follows: 1. Bone marrow suppression (Granulocyte≦1000/cmm in 11 cases) 2. Liver damage(GPT≧200 u. in 3 cases) 3. Respiratory infection (in 10 cases) 4. Urinary infection (in 3 cases) 5. Herpes zoster (in 4 cases with IgG-peak) 6. Lung fibrosis (in 2 cases with IgG-peak)