melphalan and Pain

Oral mucositis is a side effect of chemotherapy, head and neck radiotherapy, and targeted therapy, affecting over 75% of high risk patients. Ulceration can lead to severe pain and difficulty eating and drinking, which may necessitate opioid analgesics, hospitalisation and nasogastric or intravenous nutrition. These complications may lead to interruptions or alterations to cancer therapy, which may reduce survival. There is also a risk of death from sepsis if pathogens enter the ulcers of immunocompromised patients. Ulcerative oral mucositis can be costly to healthcare systems, yet there are few preventive interventions proven to be beneficial. Oral cryotherapy is a low-cost, simple intervention which is unlikely to cause side-effects. It has shown promise in clinical trials and warrants an up-to-date Cochrane review to assess and summarise the international evidence.. To assess the effects of oral cryotherapy for preventing oral mucositis in patients with cancer who are receiving treatment.. We searched the following databases: the Cochrane Oral Health Group Trials Register (to 17 June 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library 2015, Issue 5), MEDLINE via Ovid (1946 to 17 June 2015), EMBASE via Ovid (1980 to 17 June 2015), CANCERLIT via PubMed (1950 to 17 June 2015) and CINAHL via EBSCO (1937 to 17 June 2015). We searched the US National Institutes of Health Trials Registry, and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching databases.. We included parallel-design randomised controlled trials (RCTs) assessing the effects of oral cryotherapy in patients with cancer receiving treatment. We used outcomes from a published core outcome set registered on the COMET website.. Two review authors independently screened the results of electronic searches, extracted data and assessed risk of bias. We contacted study authors for information where feasible. For dichotomous outcomes, we reported risk ratios (RR) and 95% confidence intervals (CI). For continuous outcomes, we reported mean differences (MD) and 95% CIs. We pooled similar studies in random-effects meta-analyses. We reported adverse effects in a narrative format.. We included 14 RCTs analysing 1280 participants. The vast majority of participants did not receive radiotherapy to the head and neck, so this review primarily assesses prevention of chemotherapy-induced oral mucositis. All studies were at high risk of bias. The following results are for the main comparison: oral cryotherapy versus control (standard care or no treatment). Adults receiving fluorouracil-based (5FU) chemotherapy for solid cancersOral cryotherapy probably reduces oral mucositis of any severity (RR 0.61, 95% CI 0.52 to 0.72, 5 studies, 444 analysed, moderate quality evidence). In a population where 728 per 1000 would develop oral mucositis, oral cryotherapy would reduce this to 444 (95% CI 379 to 524). The number needed to treat to benefit one additional person (NNTB), i.e. to prevent them from developing oral mucositis, is 4 people (95% CI 3 to 5).The results were similar for moderate to severe oral mucositis (RR 0.52, 95% CI 0.41 to 0.65, 5 studies, 444 analysed, moderate quality evidence). NNTB 4 (95% CI 4 to 6).Severe oral mucositis is probably reduced (RR 0.40, 95% CI 0.27 to 0.61, 5 studies, 444 analysed, moderate quality evidence). Where 300 per 1000 would develop severe oral mucositis, oral cryotherapy would reduce this to 120 (95% CI 81 to 183), NNTB 6 (95% CI 5 to 9). Adults receiving high-dose melphalan-based chemotherapy before haematopoietic stem cell transplantation (HSCT)Oral cryotherapy may reduce oral mucositis of any severity (RR 0.59, 95% CI 0.35 to 1.01, 5 studies, 270 analysed, low quality evidence). Where 824 per 1000 would develop oral mucositis, oral cryotherapy would reduce this to 486 (95% CI reduced to 289 to increased to 833). The NNTB is 3, although the uncertainty surrounding the effect estimate means that the 95% CI ranges from 2 NNTB, to 111 NNTH (number needed to treat in order to harm one additional person, i.e. for one additional person to develop oral mucositis).The results were similar for moderate to severe oral mucositis (RR 0.43, 95% CI 0.17 to 1.09, 5 studies, 270 analysed, low quality evidence). NNTB 3 (95% CI 2 NNTB to 17 NNTH).Severe oral mucositis is probably reduced (RR 0.38, 95% CI 0.20 to 0.72, 5 studies, 270 analysed, moderate quality evidence). Where 427 per 1000 would develop severe oral mucositis, oral cryotherapy would reduce this to 162 (95% CI 85 to 308), NNTB 4 (95% CI 3 to 9).Oral cryotherapy was shown to be safe, with very low rates of minor adverse effects, such as headaches, chills, nu. We are confident that oral cryotherapy leads to large reductions in oral mucositis of all severities in adults receiving 5FU for solid cancers. We are less confident in the ability of oral cryotherapy to reduce oral mucositis in adults receiving high-dose melphalan before HSCT. Evidence suggests that it does reduce oral mucositis in these adults, but we are less certain about the size of the reduction, which could be large or small. However, we are confident that there is an appreciable reduction in severe oral mucositis in these adults.This Cochrane review includes some very recent and currently unpublished data, and strengthens international guideline statements for adults receiving the above cancer treatments.

Topics: Adult; Antineoplastic Agents; Cryotherapy; Fluorouracil; Hematopoietic Stem Cell Transplantation; Humans; Melphalan; Mouth Diseases; Myeloablative Agonists; Neoplasms; Pain; Randomized Controlled Trials as Topic; Stomatitis

Topics: Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Bone Marrow Transplantation; Combined Modality Therapy; Humans; Melphalan; Multiple Myeloma; Myeloma Proteins; Pain; Palliative Care; Plasmacytoma; Prednisone; Prognosis

Topics: Antineoplastic Agents; Drug Therapy, Combination; Humans; Hypercalcemia; Kidney Diseases; Melphalan; Multiple Myeloma; Myeloma Proteins; Pain; Prognosis

Multiple myeloma (MM) remains an incurable illness affecting nearly 20,000 individuals in the United States per year. High-dose melphalan (HDM) with autologous hematopoietic stem cell support (ASCT) is one of the mainstays of therapy for younger patients, but little advancement has been made with regards to conditioning regimens. We opted to combine (153)Samarium ethylenediaminetetramethylenephosphonate ((153)Sm-EDTMP), a radiopharmaceutical approved for the palliation of pain caused by metastatic bone lesions, with HDM and ASCT in a Phase II study. Individualized doses of (153)Sm were based on dosimetry and were calculated to deliver 40 Gy to the bone marrow. The therapeutic dose of (153)Sm-EDTMP was followed by HDM and ASCT. Forty-six patients with newly diagnosed or relapsed disease were treated. Study patients were compared to 102 patients contemporaneously treated with HDM and ASCT. Fifty-nine percent of study patients achieved a very good partial response (VGPR) or better. With a median follow-up of 7.1 years, the median overall survival and progression free survival (PFS) from study registration was 6.2 years (95% CI 4.6-7.5 years) and 1.5 years (1.1-2.2 years), respectively, which compared favorably to contemporaneously treated non-study patients. Addition of high-dose (153)Sm-EDTMP to melphalan conditioning appears to be safe, well tolerated, and worthy of further study in the context of novel agents and in the Phase III setting.

Topics: Adult; Aged; Bone Marrow; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Male; Melphalan; Middle Aged; Multiple Myeloma; Myeloablative Agonists; Organometallic Compounds; Organophosphorus Compounds; Pain; Peripheral Blood Stem Cell Transplantation; Radioisotopes; Radiopharmaceuticals; Radiotherapy Dosage; Salvage Therapy; Samarium; Tissue Distribution; Transplantation Conditioning

For several decades, the treatment of elderly patients with multiple myeloma (MM) has consisted of melphalan and prednisone (MP). The Dutch-Belgium Hemato-Oncology Cooperative Group (HOVON) investigated the efficacy of thalidomide added to MP (MP-T) in a randomized phase III trial. The objective of this study was to investigate the efficacy, toxicity, and effects on quality of life of MP-T.. A randomized phase III trial compared standard MP with MP-T (thalidomide 200 mg/d) in newly diagnosed patients with multiple myeloma older than age 65 years. Maintenance therapy with thalidomide 50 mg/d was administered to patients after MP-T until relapse. The primary end point was event-free survival (EFS); response rate, overall survival (OS), and progression-free survival (PFS) were secondary end points.. An intent-to-treat analysis of 333 evaluable patients showed significantly higher response rates in MP-T-treated patients compared with MP-treated patients a response (> or = partial response: 66% v 45%, respectively; P < .001; and > or = very good partial response [VGPR]: 27% v 10%, respectively; P < .001). EFS was 13 months with MP-T versus 9 months with MP (P < .001). OS was 40 months with MP-T versus 31 months with MP (P = .05).. This study demonstrates that thalidomide improves the response rate and VGPR in elderly patients with newly diagnosed MM. MP-T also results in a better EFS, PFS, and OS.

Topics: Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Female; Humans; Kaplan-Meier Estimate; Male; Melphalan; Multiple Myeloma; Multivariate Analysis; Neoplasm Staging; Neutropenia; Pain; Prednisone; Quality of Life; Regression Analysis; Thalidomide; Treatment Outcome

Forty patients with multiple myeloma scheduled to receive melphalan 200 mg/m(2) followed by autologous stem cell transplantation were randomly assigned to receive oral cryotherapy or room temperature normal saline rinses 30 min before and for 6 h after high-dose therapy. Patients were evaluated for the development of mucositis using the National Cancer Institute grading system as well as evaluation of secondary measures such as days of total parenteral nutrition (TPN), narcotic use, hospitalization, weight loss and resumption of oral caloric intake for 28 days after transplant. Patients self-scored their pain, swallowing, drinking, eating, sleeping and taste alterations for 28 days. The primary end point of this trial was the incidence of grades 3-4 mucositis. Compared to the normal saline group, patients using cryotherapy experienced less grade 3-4 mucositis, 14 vs 74%, P=0.0005. Patients receiving cryotherapy also had statistically lower uses of narcotics and TPN, although there were no differences in length of hospitalization or weight loss. Patient-reported pain was significantly lower and activities were significantly better in the cryotherapy group.

Topics: Adult; Aged; Antineoplastic Agents, Alkylating; Cryotherapy; Female; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; Pain; Peripheral Blood Stem Cell Transplantation; Prospective Studies; Stomatitis; Transplantation, Autologous

Developments in balloon catheter methodology have made hypoxic abdominal perfusion (HAP) with anti-tumour agents possible with only minimal invasive surgery. The initial reports on this modality and celiac axis stop-flow infusion for treatment of pancreatic cancer were very promising in terms of tumour response, median survival and pain reduction. Recent reports, however, have not been able to confirm these results and some have disputed the efficacy of these currently still applied treatment modalities.. Twenty-one patients with advanced pancreatic carcinoma were included in a phase I-II trial of HAP with MMC and Melphalan followed by celiac axis infusion (CAI) with the same agents six weeks later. Tumour response was assessed by abdominal-CT and by determining tumour markers. Effect on pain reduction was assessed by evaluation of pain registration forms.. HAP resulted in augmented regional drug concentrations. One patient died after CAI due to acute mesenterial ischaemia. One agent-toxicity related death was observed in the phase-I study. Significant hematological toxicity was observed after HAP and CAI at MTD. No patients were considered resectable after treatment. Median survival after HAP was 6 months (range 1-29). Pain reduction was experienced by only 5/18 patients and was short-lived.. In contrast to earlier reports HAP and CAI with MMC and Melphalan did not demonstrate any benefit in terms of tumour response, median survival and pain reduction, compared to less invasive treatment options. As this treatment was associated with significant toxic side-effects and even one procedure related death, we do not consider this a therapeutic option in patients with advanced pancreatic cancer.

Topics: Aged; Antineoplastic Agents; Balloon Occlusion; Chemotherapy, Cancer, Regional Perfusion; Female; Humans; Hypoxia; Infusions, Intra-Arterial; Male; Melphalan; Middle Aged; Mitomycin; Pain; Pain Measurement; Pancreatic Neoplasms; Remission Induction; Treatment Outcome

Amifostine (WR-2721; Ethyol) is a well-known cytoprotector, but a possible role in preventing extrahaematological toxicity after high-dose therapy (HDT) has never been investigated. We compared two historical groups of patients who either received (group A, n = 35) or did not receive (group B, n = 33) amifostine (740 mg/m2) before high-dose (HD) melphalan, followed by autologous infusion of peripheral blood progenitor cells (PBPCs). Amifostine was well tolerated at this dose level. Emesis grade 1-2 was the most important side-effect, but the interruption of infusion was never required. The incidence and median duration of severe mucositis (grade 3-4) was 21% and 0 d (range 0-11 d) in group A and 53% and 7 d (range 0-11 d) in group B. The duration of analgesic therapy was also significantly lower in group A (0 d; range 0-12) than in group B (6 d, range 0-20) (P = 0.0001). Severe diarrhoea (3% vs. 25%; P = 0.01) and emesis (9% vs. 34%; P = 0.01) were also reduced in group A in comparison with group B. No differences were observed between the two groups for haematological recovery. This retrospective study strongly suggests that amifostine can reduce severe mucositis and the use of analgesic drugs in this setting. A randomized study is warranted to confirm these preliminary results.

Topics: Adolescent; Adult; Aged; Amifostine; Analgesics, Opioid; Antineoplastic Agents, Alkylating; Blood Cell Count; Diarrhea; Drug Therapy, Combination; Female; Hematopoietic Stem Cell Transplantation; Humans; Male; Melphalan; Middle Aged; Mouth Mucosa; Pain; Radiation-Protective Agents; Retrospective Studies; Stomatitis; Treatment Outcome; Vomiting

In order to study whether oral bisphosphonate therapy might prevent or reduce skeletal-related morbidity in patients with newly diagnosed multiple myeloma who required chemotherapy, 300 patients were included in a randomized multi-centre trial. Patients were given oral pamidronate at a dose of 300 mg daily, or placebo, in addition to conventional intermittent melphalan/prednisolone (and in some cases alpha-interferon) treatment. With a median treatment duration of about 550d, no statistically significant reduction in skeletal-related morbidity (defined as bone fracture, related surgery, vertebral collapse, or increase in number and/or size of bone lesions) could be demonstrated. Pamidronate treatment also did not have any influence on patient survival or on the frequency of hypercalcaemia. However, in patients treated with pamidronate there were fewer episodes of severe pain (P=0.02) and a decreased reduction of body height of 1.5 cm (P= 0.02). The overall negative result of the study is attributed to the very low absorption of orally administered bisphosphonates in general.

Topics: Administration, Oral; Aged; Anti-Inflammatory Agents; Antineoplastic Combined Chemotherapy Protocols; Body Height; Bone Diseases; Diphosphonates; Double-Blind Method; Female; Fractures, Bone; Humans; Hypercalcemia; Male; Melphalan; Multiple Myeloma; Pain; Pamidronate; Prednisolone; Treatment Failure

Measurement of health-related quality of life was integrated into a randomized trial (NMSG 4/90) comparing melphalan/prednisone to melphalan/prednisone + interferon alpha-2b in newly diagnosed multiple myeloma. One of the aims of the study was to assess the prognostic significance of quality-of-life scores, using the EORTC QLQ-C30 questionnaire. Univariate analysis showed a highly significant association with survival from the start of therapy for physical functioning as well as role and cognitive functioning, global quality of life, fatigue and pain. In multivariate analysis, physical functioning and W.H.O. performance status were independent prognostic factors (P values = 0.001 for both) when analysed in a Cox regression model with the somatic variables beta-2 microglobulin, skeletal disease and age. The best prediction for survival from the start of therapy was obtained by combining the beta-2 microglobulin and physical functioning scores in a variable consisting of three risk factor levels with an estimated median survival of 17, 29 and 49 months, respectively. At a 12 months landmark analysis, the relative risk for patients with physical functioning score 0-20 v 80-100 was 5.63 (99% CI 2.76-11.49), whereas the relative risk for patients without an objective response to chemotherapy compared to those with at least a minor response was 2.32 (99% CI 1.44-3.74). Quality-of-life assessment may be an independent and valuable addition to the known prognostic factors in multiple myeloma.

Topics: Activities of Daily Living; Aged; Antineoplastic Combined Chemotherapy Protocols; Fatigue; Forecasting; Health Status; Humans; Interferon alpha-2; Interferon-alpha; Melphalan; Multiple Myeloma; Multivariate Analysis; Pain; Prednisone; Prospective Studies; Quality of Life; Recombinant Proteins; Risk Factors; Survival Analysis; Treatment Outcome

In a Nordic multi-centre trial, 583 previously untreated multiple myeloma patients were randomized to receive melphalan-prednisone or melphalan-prednisone+ interferon alpha-2b at a dose of 5 million units subcutaneously, 3 d/week. A quality-of-life study was integrated into the trial, using the EORTC QLQ C-30 questionnaire supplemented with 11 questions concerning interferon toxicity. The questionnaire was completed prior to treatment and after 1, 6, 12, 24, 36 and 48 months. 90% of the patients participated in the quality-of-life study, and 83% completed all questionnaires submitted to them. During the first year of treatment the patients on interferon reported significantly more fever, chills, dry skin, fatigue, pain, nausea/vomiting and appetite loss than the control patients. There was a moderate reduction of the global quality-of-life score and slight, non-significant, reductions of physical, emotional, cognitive, social and role functioning scores. After the first year there were no statistically significant differences in any toxicity, symptom or quality-of-life score, except for an increased frequency of dizziness in the interferon group. As only 60% of the patients remained on interferon after 24 months, our data probably underestimate the potential toxicity of the drug. Although there was no significant survival benefit for the interferon patients, a 5-6 months prolongation of the response and plateau phase duration was observed. However, by intention-to-treat analysis, there was no late quality-of-life benefit for the interferon patients to compensate for the early impairment. Thus, the clinical significance of the plateau-phase prolongation is uncertain.

Topics: Activities of Daily Living; Aged; Antineoplastic Combined Chemotherapy Protocols; Fatigue; Feeding and Eating Disorders; Fever; Humans; Interferon alpha-2; Interferon-alpha; Melphalan; Multiple Myeloma; Nausea; Pain; Prednisone; Quality of Life; Recombinant Proteins; Social Behavior; Vomiting

Interferon (INF) has been incorporated as part of maintenance therapy after high dose treatment in order to make remissions more durable. In this study we have compared peripheral blood stem cell transplant (PBSCT) versus autologous bone marrow transplant (ABMT) with respect to INF tolerance. Thirty nine PBSCT patients have been compared to 37 ABMT patients for INF tolerance. This is followed by a comparison of 15 PBSCT patients versus 21 ABMT patients for engraftment details, response and survival. INF was started at a median of 61 days in the PBSCT and 58 days in the ABMT patients (P = NS). It was well tolerated in both groups without a significant difference in toxicity in the two arms. Engraftment was more rapid in the PBSCT patients with platelet recovery being significantly faster. Response and survival showed a favourable trend for ABMT patients though statistical significance was not reached and the cost of PBSCT was 12% cheaper. We were thus able to conclude that PBSCT grafts were as durable and could tolerate INF just as well as ABMT. Engraftment was more rapid and the procedure of PBSCT was also cheaper. Further studies with a larger group of patients will be required before comments on the efficacy of treatment can be made.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Transplantation; Combined Modality Therapy; Disease-Free Survival; Fatigue; Female; Fever; Graft Survival; Hematopoietic Stem Cell Transplantation; Humans; Immunologic Factors; Interferon alpha-2; Interferon-alpha; Life Tables; Male; Melphalan; Middle Aged; Multiple Myeloma; Pain; Recombinant Proteins; Remission Induction; Survival Analysis; Thrombocytopenia; Transplantation, Autologous; Treatment Outcome

The authors report the results obtained from the treatment of 13 cases of myeloma by cyclic chemotherapy (melphalan) applied after cellular synchronization with vincristine. The clinical results (maximum 2 years after treatment) were good in 11 cases out of 13. The following laboratory values quickly returned to normal: sedimentation and calcaemia, but there was little change in the immunoglobulins.

Topics: Aged; Anemia; Blood Sedimentation; Bone Neoplasms; Clinical Trials as Topic; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Hypercalcemia; Male; Melphalan; Middle Aged; Mitosis; Multiple Myeloma; Pain; Periodicity; Vincristine

Topics: Antineoplastic Agents, Alkylating; Dyspnea; Fatigue; Humans; Immunoglobulin Light-chain Amyloidosis; Melphalan; Pain; Prospective Studies; Quality of Life; Sleep Initiation and Maintenance Disorders; Treatment Outcome

Topics: Drug Administration Schedule; Exanthema; Fibroblast Growth Factor 7; Humans; Melphalan; Morphine; Mouth Mucosa; Mucositis; Multiple Myeloma; Pain; Recombinant Proteins; Stem Cell Transplantation; Treatment Outcome

High-dose melphalan and autologous hematopoietic stem cell transplantation (HSCT) is a standard treatment for myeloma, but very little is known about the psychosocial or quality-of-life difficulties that these patients encounter during treatment. Data regarding older patients is particularly scarce. Using a prospective design, this investigation evaluated 94 patients at stem cell collection and again after high-dose therapy and transplantation. Outcomes included quality-of-life (FACT-BMT) and psychosocial adjustment (ie, Brief Symptom Inventory, Impact of Events Scale, and Satisfaction with Life Scale). Findings were compared with age- and sex-adjusted population norms and with transplantation patient norms. At stem cell collection, physical deficits were common, with most patients scoring 1 standard deviation below population norms for physical well-being (70.2%) and functional well-being (57.5%), and many reporting at least moderate fatigue (94.7%) and pain (39.4%). Clinically meaningful levels of anxiety (39.4%), depression (40.4%), and cancer-related distress (37.0%) were evident in a notable proportion of patients. After transplantation, there was a worsening of transplant-related concerns (P < .05), depression (P < .05), and life-satisfaction (P < .001); however, pain improved (P < .01), and social functioning was well preserved. Overall, the declines in functioning after transplantation were less pronounced than anticipated. Older patients were not more compromised than younger ones; in multivariate analyses, they reported better overall quality of life (P < .01) and less depression (P < .05) before transplantation. Our findings emphasize the importance of early screening and intervention.

Topics: Adaptation, Psychological; Adult; Age Factors; Aged; Depression; Female; Hematopoietic Stem Cell Transplantation; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; Pain; Quality of Life; Social Adjustment; Transplantation, Autologous; Treatment Outcome

The aim of the study was to determine the activity and toxicity of melphalan as a single agent given in up-front therapy for patients with newly-diagnosed Ewing's family tumours with bone/bone marrow metastases. Nineteen patients were enrolled from 2001 to 2004. The treatment consisted of up-front therapy with melphalan (two courses of 50 mg/m2, 3 weeks apart). The overall rate of response to melphalan (complete response+partial response, according to the RECIST criteria) was 78%. Transient grade 3-4 neutropenia, thrombocytopenia and anaemia were recorded in 97%, 81% and 28% of melphalan courses, respectively. No other relevant toxicities were recorded. Melphalan proved to be active in up-front treatment at non-myeloablative doses, and its toxicity was predictable and manageable. The schedule adopted did not interfere with any further intensive chemotherapy or myeloablative treatment in the majority of cases.

Topics: Adolescent; Adult; Antineoplastic Agents, Alkylating; Bone Marrow Neoplasms; Bone Neoplasms; Child; Female; Humans; Male; Melphalan; Pain; Pedigree; Sarcoma, Ewing; Survival Analysis; Treatment Outcome

The incidence of mucositis caused by autologous hematopoietic stem cell transplantation (AHSCT) is relatively high. The severe painful mucositis can reduce the quality of life of patients obviously. Transdermal fentanyl is efficient in treating chronic pain of cancer, and also can relieve the severe pain of mucositis resulted from chemotherapy. This study was to investigate the efficacy and safety of transdermal fentanyl for the severe painful mucositis caused by AHSCT.. A total of 22 malignant tumor patients suffered from severe mucositis caused by high dose chemotherapy combined AHSCT. The analgesic degree before and after treatment was evaluated by the scores of Visual Analogue Scale (VAS) (range 0-10). The median VAS scores of all patients were above 4 (moderate to severe pain) before the administration of transdermal fentanyl. The quality of life before and after treatment was evaluated by the Standard of Quality of Life drew up in China in 1990. The adverse events after treatment were evaluated by Common Toxicity Criteria formulated by National Cancer Institute of the USA.. The median VAS score has been decreased from baseline at 6 (4-9) to 3.5 (0-9) on Day 3, 2 (0-6) on Day 5, 0.5 (0-8) on Day 7, 0 (0-6) on Day 10, and 0 (0-5) on Day 15 after treatment (P<0.001). The overall response rate was 100%, while the complete response rate was 45.5%. The quality of life of the patients was improved significantly (P<0.01). The adverse events after treatment of transdermal fentanyl included dizziness, somnolence, dysuria, mild and transient nausea, vomiting, discomfort of stomach, and so on. All the adverse events disappeared within several days after proper managements. Neither severe adverse event nor drug addiction was found.. Transdermal fentanyl has good analgesic effect on painful severe mucositis induced by AHSCT. It is convenient and well tolerated, and could improve quality of life significantly.

Topics: Administration, Cutaneous; Adolescent; Adult; Analgesics, Opioid; Antineoplastic Combined Chemotherapy Protocols; Carmustine; Child; Child, Preschool; Combined Modality Therapy; Cytarabine; Female; Fentanyl; Hematopoietic Stem Cell Transplantation; Humans; Lymphoma, Non-Hodgkin; Male; Melphalan; Middle Aged; Mucositis; Pain; Pain Measurement; Podophyllotoxin; Quality of Life; Transplantation, Homologous; Young Adult

Topics: Antineoplastic Agents, Alkylating; Cryotherapy; Female; Humans; Male; Melphalan; Multiple Myeloma; Pain; Peripheral Blood Stem Cell Transplantation; Prospective Studies; Stomatitis; Transplantation, Autologous

Sweet's syndrome is an uncommon acute skin disease, associated with a variety of medical problems. The drug-induced variant is even rarer. We describe two cases of this syndrome associated with the administration of the proteasome inhibitor bortezomib. The diagnostic criteria for drug-induced Sweet's syndrome as proposed by Walker and Cohen were fulfilled. Vasculitis and neutrophilic eccrine hidradenitis were excluded.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Boronic Acids; Bortezomib; Drug Administration Schedule; Erectile Dysfunction; Humans; Immunosuppressive Agents; Male; Melphalan; Methylprednisolone; Multiple Myeloma; Pain; Peripheral Nervous System Diseases; Prednisolone; Protease Inhibitors; Pyrazines; Recurrence; Sleep Initiation and Maintenance Disorders; Sweet Syndrome; Testicular Diseases

The osteoid of a patient with Fibrogenesis Imperfecta Ossium is described. Three iliac crest biopsies were taken; firstly before treatment, secondly after calcitriol therapy and finally after successful treatment with melphalan and prednisolone. In the pretreatment biopsy the osteoid was greatly enlarged, showed complete absence of the birefringence characteristic of oriented collagen fibers, and at ultrastructural level was shown to be composed of abnormal collagen fibrils. The fibrils were often curved and were extremely variable in thickness. Calcification within the osteoid took the form of calcospherites and spread of calcification from these to collagen fibrils was greatly delayed. In the second biopsy two aspects of osteoid ultrastructure were noted; some samples resembled the first biopsy, but others had a different organization. The osteoid of these samples had two regions: an inner region containing abnormal collagen fibrils and an outer region composed of moderately electron-dense amorphous material. The osteoblasts associated with this region were clearly highly biosynthetically active. The third biopsy, after treatment with Melphalan and prednisolone, showed a reversion to more normal bone ultrastructure with uniform, oriented collagen fibrils and prompt mineralization resulting in narrow osteoid seams. Remnants of the original abnormal osteoid were present in the marrow space as calcified debris. Reasons for the success of this therapeutic regime are unclear; however, some speculation is made as to the possible roles of the cytotoxic drug and the glucocorticoid in the regression of this condition.

Topics: Biopsy; Bone and Bones; Bone Diseases; Calcification, Physiologic; Calcitriol; Collagen; Humans; Male; Melphalan; Microscopy, Electron; Middle Aged; Pain; Prednisolone

33 patients with advanced refractory multiple myeloma received a combination of vincristine, cyclophosphamide, carmustine, melphalan and steroids (M-2 protocol). 20 of them had failed prior chemotherapy with alkylating agents and the remaining 13 patients had relapsed after a response to these drugs. An objective tumour cell mass reduction (greater than or equal to 50%) was achieved in 17% of the patients (6% of previously nonresponders and 33% of previously relapsing), while 9 additional patients improved (30-50% tumour reduction), for an overall response rate of 47% (39% for previously nonresponders and 58% for previously relapsing). The median duration of response was 7 months. Thrombocytopenia was the most common toxicity encountered in the study (39% of cases). Our findings indicate that M-2 protocol is an effective salvage treatment for patients who relapse from previous chemotherapy with alkylating agents. In contrast, results in patients who are primarily resistant to these drugs justify the search for different treatment programmes which can produce greater degrees of tumour reduction.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bone and Bones; Bone Marrow; Carmustine; Cyclophosphamide; Drug Resistance; Hemoglobins; Humans; Melphalan; Middle Aged; Multiple Myeloma; Neoplasm Recurrence, Local; Pain; Prednisone; Time Factors; Vincristine

Criteria for the diagnosis of multiple myeloma and differential diagnostic considerations are presented. The indications for treatment are discussed. Combination of melphalan or cyclophosphamide with prednisone may be considered standard therapy today. This produces objective tumor regression in 50-70% of patients. The parameters for determining remission and their significance with regard to survival and tumor cell mass are discussed. The importance of supportive measures is stressed. Persistent problems and potential for improving present therapy are discussed.

Topics: Blood Transfusion; Cyclophosphamide; Drug Therapy, Combination; Humans; Melphalan; Multiple Myeloma; Orthopedic Equipment; Pain; Plasmapheresis; Prednisone; Prognosis; Remission, Spontaneous

The experience of a solo practitioner suggests that the incidence of multiple myeloma is higher than the widely reported figure of 2.7/100,000. Only by early recognition and treatment will the survival rate be increased. Measurement of the sedimentation rate may be helpful in spotting the disease, for a rapid rate in patients with bone pain and anemia suggests multiple myeloma.

Topics: Adult; Anemia; Blood Sedimentation; Bone Diseases; Female; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; Pain; Prednisone

Topics: Blood Viscosity; Bone Diseases; Cyclophosphamide; Fluorides; Humans; Hypercalcemia; Melphalan; Multiple Myeloma; Myeloma Proteins; Pain; Phosphates; Plasmapheresis; Prednisolone; Procarbazine; Vincristine

Topics: Albuminuria; Bence Jones Protein; Bone Neoplasms; Cyclophosphamide; Female; Fractures, Spontaneous; Glucocorticoids; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; Pain; Prognosis

Topics: Adrenal Cortex Hormones; Albuminuria; Bence Jones Protein; Bone Neoplasms; Cyclophosphamide; Fractures, Spontaneous; Humans; Melphalan; Multiple Myeloma; Pain

Topics: Bone Diseases; Calcium; Female; Humans; Male; Melphalan; Myeloproliferative Disorders; Nitrogen Mustard Compounds; Pain