浆细胞肿瘤（复发或难治性多发性骨髓瘤）治疗方案
权威癌症研究机构美国国家癌症研究所 (NCI)对浆细胞肿瘤（复发或难治性多发性骨髓瘤）治疗方案：
化疗（细胞毒性药物）方案：
一、美法仑。 [1,2]
二、长春新碱+多柔比星（输注）+地塞米松（VAD）。 [3,4]
三、环磷酰胺（CyBorD方案+硼替佐米+地塞米松）。 [5,6]
四、聚乙二醇化脂质体阿霉素（在改良的VAD方案中）[7,8] 或与硼替佐米和地塞米松联合使用。[9]
化疗（硼替佐米）治疗浆细胞肿瘤（复发或难治性多发性骨髓瘤）医学证据
1.一项随机前瞻性试验的荟萃分析将美法仑和泼尼松与其他细胞毒性药物的组合进行了比较；PFS或OS未发现差异。[9][证据级别：1iiA ]
2.VAD方案在以前未治疗的患者和复发患者中显示出活性，反应率从 60% 到 80% 不等。[10,11][证据级别：3iiiDiv ] 由于物流问题，提供96小时多柔比星输注, 用聚乙二醇化脂质体多柔比星替代提供了相当的反应率。 [7,8]
在用尽大多数新方案后，仅使用化疗就可以获得临床缓解，从而改善患者的表现状态，从而允许随后使用研究替代疗法的临床试验。
参考资料：
[1]Gregory WM, Richards MA, Malpas JS: Combination chemotherapy versus melphalan and prednisolone in the treatment of multiple myeloma: an overview of published trials. J Clin Oncol 10 (2): 334-42, 1992.
[2]Combination chemotherapy versus melphalan plus prednisone as treatment for multiple myeloma: an overview of 6,633 patients from 27 randomized trials. Myeloma Trialists' Collaborative Group. J Clin Oncol 16 (12): 3832-42, 1998.
[3]Segeren CM, Sonneveld P, van der Holt B, et al.: Vincristine, doxorubicin and dexamethasone (VAD) administered as rapid intravenous infusion for first-line treatment in untreated multiple myeloma. Br J Haematol 105 (1): 127-30, 1999.
[4]Anderson H, Scarffe JH, Ranson M, et al.: VAD chemotherapy as remission induction for multiple myeloma. Br J Cancer 71 (2): 326-30, 1995.
[5]Reece DE, Rodriguez GP, Chen C, et al.: Phase I-II trial of bortezomib plus oral cyclophosphamide and prednisone in relapsed and refractory multiple myeloma. J Clin Oncol 26 (29): 4777-83, 2008.
[6]Knop S, Liebisch H, Wandt H, et al.: Bortezomib, IV cyclophosphamide, and dexamethasone (VelCD) as induction therapy in newly diagnosed multiple myeloma: results of an interim analysis of the German DSMM Xia trial. [Abstract] J Clin Oncol 27 (Suppl 15): A-8516, 2009.
[7]Dimopoulos MA, Pouli A, Zervas K, et al.: Prospective randomized comparison of vincristine, doxorubicin and dexamethasone (VAD) administered as intravenous bolus injection and VAD with liposomal doxorubicin as first-line treatment in multiple myeloma. Ann Oncol 14 (7): 1039-44, 2003.
[8]Rifkin RM, Gregory SA, Mohrbacher A, et al.: Pegylated liposomal doxorubicin, vincristine, and dexamethasone provide significant reduction in toxicity compared with doxorubicin, vincristine, and dexamethasone in patients with newly diagnosed multiple myeloma: a Phase III multicenter randomized trial. Cancer 106 (4): 848-58, 2006.
[9]Combination chemotherapy versus melphalan plus prednisone as treatment for multiple myeloma: an overview of 6,633 patients from 27 randomized trials. Myeloma Trialists' Collaborative Group. J Clin Oncol 16 (12): 3832-42, 1998.
[10]Segeren CM, Sonneveld P, van der Holt B, et al.: Vincristine, doxorubicin and dexamethasone (VAD) administered as rapid intravenous infusion for first-line treatment in untreated multiple myeloma. Br J Haematol 105 (1): 127-30, 1999.
[11]Anderson H, Scarffe JH, Ranson M, et al.: VAD chemotherapy as remission induction for multiple myeloma. Br J Cancer 71 (2): 326-30, 1995.
