| Candidate DU Huaping Mentor HUANG Jinwen Hematology devision, Internal medicineSir Run Run Shaw Hospital Medical School, Zhejiang UniversityBackgroundMultiple myeloma (MM) is a neoplastic proliferative disease of a single clone of plasma cell which home to bone marrow, characterized by producing monoclonal protein and osteolytic lesions. It's a common hematological tumor and accounts for approximately 10 percent of hematological malignancies. Curable therapy is not available for multiple myeloma. At 40 years, the standard regimen is melphalan and prednisone (MP). The response rate is close to 50%. The regimen else may be more effective but without significance on overall survival.Melphalan antitumor activity is through blocking the duplication of DNA of tumor cells. The proliferation of myeloma cells not only dependents on themselves'duplication but also is related to their microenvironment of bone marrow. The stroma cells secret cytokines such as TNF- a , TGF- 0 > VEGF which play vital roles in angiogenesis. And adhesion of myeloma cells to stroma cells triggers secretion of cytokines such as IL-6, IL-10 that augments MM cell growth and survival and confers drug resistance. Thalidomide may modulate adhesive interactions, down regulate the TNF- a and alter secretion and bioactivity of cytokines. Furthermore, thalidomide may act directly in MM cell by inducing apoptosis or Gl growth arrest. Therefore we considered combining thalidomide with MP regimen to treat MM patients.Thalidomide (thai), (alpha)-(N-phthalimido)glutarimide, is a synthetic derivative of glutamic acid. It was designed and synthesized by a German company in the mid-1950s and advocated to ensure a good night's sleep and to prevent morning sickness in pregnancy. However, soon after its approval in Europe in 1957, it was suggested that thalidomide was associated with life-threatening birth defects in babies exposed to thalidomide in uteri during early pregnancy. Consequently, thalidomide was withdrawn from the market. In the 1990s, thalidomide was granted Food and Drug Administration (FDA) approval for treatment of erythema nodosum leprosy (ENL) in the USA under very strict controls. And it was then used in HIV infection, GVHD, MM, etc.Thalidomide now is to practice in various type of plasma disease. It is used to treat relapse and refractory MM, as well as on monoclonal gammopathy with undetermined significance (MGUS) and smoldering multiple myeloma (SMM). Some researchers combined thalidomide with dexamethasone (DXM), whichcalled DT regimen as pretreatment of peripheral blood stem cell transplantation. However, the dose, the response time and the maintenance time of thalidomide treated MM are not clear. The dose of thalidomide was varied from 50 mg to 800 mg; the response time was during 28-60 days. Most side effects such as constipation, skin rash, dizziness of thalidomide were mild despite some with high dose thalidomide had severe side effect and had to retire the study.We reported here clinic experience of therapy in 12 multiple myeloma patients with thalidomide combined with MP regimen.1 Patients and Methods1.1 Patients Total 12 patients who were newly diagnosed as multiple myeloma and sensitive to MP regimen were treated oral thalidomide combined with MP regimen. Newly diagnosed patients were 8 cases others for 4 cases. There were 6 female and 6 male patients with the median age 67.8 years. IgG subgroup for 5 cases with the mean level of 70.74 g/L, IgA for 3 cases with the mean level of 33.96 g/L. Light chains KS X were happened in two patients. The subgroups of 2 cases were not clear. The median bone marrow plasma cell was 29.7%. The median hemoglobin was 63.75 g/Lo Patients with abnormality of renal function were 3 cases. Patients with I degree were 2 cases and III for 10 cases. Quality of life for 1 grade were 5 cases, 2 grade for 3 cases, 3 grade for 2 cases, 4 grade for 2 cases.1.2 Methods Thalidomide combined with MP regimen: Thalidomide was continuously given. It was adminis...
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