持续口服小剂量环磷酰胺联合泼尼松治疗复发/难治性多发性骨髓瘤伴严重心功能不全患者疗效观察

OBJECTIVE: To observe treatment response, survival, safety and the improvement of ECOG in patients with refractory multiple myeloma (MM)with serious heart failure after the administration of continuous low-dose of cyclophosphamide combined with prednisone (CP). METHODS: From January 2005 to September 2013, a total of 75 patients were treated by metronomic chemotherapy with continuous low-dose cyclophosphamide (50 mg/d) and prednisone (15 mg/d). RESULTS: Among the 75 patients, 2 were lost for follow-up. In the 73 available patients, the overall response was 64.4%, including 2 patients (2.7%) with complete remission (CR), 4 cases (5.5%) very good partial remission (VGPR), and 24 patients (32.9%) partial remission (PR). The median survival was 12 months (1–70 months) with a median onset time of 90 days (16–120) and a median progressive freedom survival of 12 months (1–60). The level of B-type natriuretic peptide in responders declined significantly, as compared to no responders [(336.6±30.3) ng/L vs (906.4±104.8) ng/L, P<0.01]. Common adverse events were as follows: 32 (43.8%) cases of bone marrow suppression, 26 (35.6%) cases of infection, 8 cases of dizzy as well as sleepiness (11.0%), 7 (9.6%) cases of Cushing syndrome, 4 (5.5%) cases of secondary diabetes mellitus, and 3 (4.1%) cases of edema respectively. CONCLUSION: The metronomic chemotherapy of cyclophosphamide combined with prednisone had satisfactory impact on the treatment outcome, including the improvement of cardiac functions and physical capacities, better survival and safety in refractory MM with serious heart failure. It provides a novel regimen for such patients.