课件：浆细胞病.pptVIP

* * Incidence of all grades reported. * For fluid intake i.e. water, Ricelyte, Pedialyte, sports drinks, diluted fruit juices and broth. Loperamide (Imodium) 4 mg followed by 2 mg every 4 hours or after each unformed stool (maximum 16mg/day). May take 4 mg every 4 hours at night to allow sleep). atropine-diphenoxylate (Lomotil) 1 to 2 tablets every 6-8 hours Tincture of opium 0.6 ml PO every 4 – 6 hours sandostatin (Octreotide) 100 - 150 ug s.c., TID * * MOA: Steroids appear to cause apoptosis, thus can trigger the destruction of myeloma cells Steroids have the following advantages: Shrink plasmacytomas through apoptosis Reduce neurological pressure Reduce hypercalcemia Achieve overall control of the disease Dexamethasone and Prednisone are two commonly used steroids for Multiple Myeloma In patients with renal failure, they can be used without dose adjustment. In patients who have low blood counts, they can be used without fear of further reduction in counts. * * Concluding slide on general recommendations for side effect management of all 5 emergent side effects Myelosuppression, DVT/PE, Peripheral neuropathy, GI and steroid * 虽然，在DVD方案中减少了地塞米松的剂量，但疗效依旧。总有效率为88%: 4例(12%)患者获得完全缓解，18 例(55%) 患者获得显著缓解, 7例(21%)患者获得微小缓解。 3例患者(9%)病情稳定而仅1例(3%)患者疾病进展。 * 3年的总生存率为67％。 * Slide 46. Thalidomide (Thalomid?) Thalidomide, an immunomodulatory agent, is currently approved for treatment of ENL. This agent has been shown to improve the response rates in combination therapy with chemotherapy, alkylating agents, and steroids. Currently, the NCCN recommends thalidomide and dexamethasone treatment as primary therapy for newly diagnosed MM and also as salvage therapy upon failure of other chemotherapeutic regimens * * * * * * Slide 81. Bortezomib (PS 341; Velcade?) The proteasome is a multi-subunit enzyme complex that plays a role in the regulation of cell-cycle progression and apoptosis. Bortezomib is a proteasome inhibitor that has been shown to h