[Therapeutic results and changes in prognosis in patients with multiple myeloma in central and northern Moravia over the past 40 years].
OBJECTIVE
The objective of the investigation is evaluation of therapeutic results and the development of the prognosis of patients with multiple myeloma (MM) as a result of consecutive changes of therapeutic procedures in patients of central and northern Moravia in the course of the last 40 years.


RESULTS
The analyzed group of 562 patients with MM was concentrated at the Ist and IIIrd Medical Clinic of the Faculty Hospital Olomouc in 1959 - 2000, median age 63 (28-91) male/female ratio 1.1: 1.0. From analysis of Kaplan-Meier survival curves and the results of statistical analysis (log rank test p = 0.0000) ensued that during the evaulated period a very substantial change of prognosis occurred with improvement of theraupeutic  results and a significant prolongation of survival in general. The first " turning point" was the introduction of chemotheraphy with alkylating substances with Prednisone (1963-1975), leading as compared with the period of  symptomatic treatment alone (1959-1063) to a significant prolongation of the media value of general survival (M) from 8 to 19 months (p = 0.0031) and 3-year survival from 4 to 23 % patients, whereby 10-year survival was only 0 %   and 1 %. The second "turning point" was the period from 1976 - 1980 with introduction of systematic chemotherapy using conventional doses of  polychemotherapeutic (CP) regimes with better opportunities of supporting treatment (M = 40 months, p = 0.0000; 3-year and 10-year survival 55% and 5.5% patients). The therapeutic results acheived during the subsequent 15 years were however an unsatisfactory advance. During the interval between 1976-1995 in a group of 295 patients divided into 5-year sub-periods remission was acheived  (R = < 25 % of the baseline value of    M-protein) in 10-24 % patients, an inadequate response (NR) =  persistence in > 50 % M-protein) in 55-28 %, prolongation of the median of total survival in 232 of  the accessble patients for 44 months and long-term survival of 5 - 10 years after establisment of  the diagnosis increased from 25 to 36 % and from 5.5 to 16.5 % patients. The third "turning point" was 1996 characterized by the introduction of high-dosage chemotheraphy with transplantation of autologuos peripheral haematopoietic cells ("HD" therapy with ASCT) leading ina group of so far only 33, assessable patients under 65 years to acheived remission in 71 %, to decline of  NR in  10 % only and 5 -year suvival so far in 91 % patients ( p = 0.0037). Improvement of therapeutic results and prognosis of  the disease as compared with  1976 - 1995 occurred in the whole group of patients also in 1996 - 2000 (CP and "HD"-therapy with ASCT) characterized by remission in 36 %, NR IN 33 % and 5 -year survival in 57 % (p = 0.030). It  was reveled that the application of "HD" theraphy with ASCT led in 1995-2000 to the acheivement of more favorable therapeutic results (R - 71 % NR - 10 %. 5-year survival after the interval which elapsed so far 91 %), as compared  with 2 similar groups of subjects under 65 years meeting the criteria of "HD"  theraphy with ASCT, but treated only by conventional polychemotheraphy (1991 - 1995 and 1996 - 2000: R - 24 and 32 %, NR - 42 and 23 %, 5-year survival 46 and 68 % of the patients). In the group of 148 patients from the period of 1991-2000 the patients had as regards remission (R) more favourable results as compared with patients with NR concerning the prognosis [M 63 vs.22 months, 5-year and 10-year survival 53 vs. 17 % and 17 vs. 0 % of patients (p = 0.0000)].


CONCLUSIONS
From the submitted analysis ensured that during the period form 1959 - 2000 in patients with mutiple myeloma in central and northern Moravia as a result of the application of  modern methods of chemotheraphy and supporting treatment a significant improvements of   results  of conventional treatment occurred with a more than 5 fold prolongation of so far assessable median values of survival (8 - 44 months) and long-term 10-year survival of almost one sixth of the patients. The real asset of   "HD" theraphy with transplantation of ASCT will be revealed by analyses made after a longer time interval.
Scudla
V
V
III. interní klinika Lékarské fakulty UP a FN, Olomouc.
Bacovský
J
J
Indrák
K
K
Kod'ousková
V
V
Vytrasová
M
M
Faber
E
E
Papajík
T
T
Vavrdová
V
V
Adam
Z
Z
Hájek
R
R
Farbiaková
V
V
Srovnalík
K
K
Novosadová
L
L
Vránová
M
M
Micaníková
M
M
Sumná
E
E
Kuca
B
B
Slezar
J
J
Heincová
V
V
Gumulec
J
J
Zivná
J
J
Schlemmer
P
P
Lautnerová
E
E
Lasota
Z
Z
Kubecková
M
M
Krajsová
I
I
Růzicka
M
M
Cíhal
K
K
Martínek
A
A
Cernosek
B
B
Doubravský
J
J
Papajík
J
J
Prodĕlal
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
D000970:Antineoplastic Agents