不同化疗方案对多发性骨髓瘤的疗效观察

目的分析不同化疗方案对多发性骨髓瘤患者的疗效。方法总结2002年12月～2003年12月本院采用标准化疗方案(联合或不联合反应停)治疗的25例多发性骨髓瘤患者的临床资料。结果25例患者中15例有效，总有效率为60．O％。M2、MP、VAD方案有效率各为55．6％(5／9)、50％(2／4)、66．7％(8／12)。8例联合反应停治疗的难治的多发性骨髓瘤患者中，完全缓解2例，有效4例。结论反应停联合化疗可作为初发或难治的多发性骨髓瘤的治疗选择。     

反应停联合三氧化二砷治疗多发性骨髓瘤14例疗效观察

①目的观察反应停联合三氧化二砷治疗多发性骨髓瘤的疗效及不良反应。②方法确诊的多发性骨髓瘤患者14例,反应停起始剂量为lOOmg／天,睡前顿服,1周后逐渐加量至200mg／天;三氧化二砷10mg加5％葡萄糖500mL,静滴,1～14天,28天为1个周期,2疗程后评估疗效。③结果14例患者中,部分缓解5例,进展6例,有效率为78．6％。不良反应有嗜睡、便秘、恶心呕吐、肝功能受损、浮肿等。④结论反应停联合三氧化二砷治疗多发性骨髓瘤疗效明显,患者耐受性可,特别适用老年患者。     

小剂量反应停联合化疗治疗多发性骨髓瘤的临床研究

目的：探讨小剂量反应停联合化疗治疗多发性骨髓瘤（MM）的临床疗效,方法：治疗组小剂量反应停（50～200mg／日）联合化疗,对照组常规化疗,对其临床疗效进行对比分析。结果：治疗组nCR2例,PR10例,ORR60％：对照组nCR1例,PR8例,ORR30％。治疗组疗效优于对照组且具有统计学意义,治疗过程中无不能耐受的不良反应。结论：小剂量反应停增加化疗的疗效。     

三氧化二砷联合反应停治疗难治或复发性多发性骨髓瘤30例

目的分析三氧化二砷（ATO）联合反应停治疗难治或复发性多发性骨髓瘤（MM）临床疗效。方法三氧化二砷0．16mg／kg．d、反应停初始剂量100mg／d。每周加量50mg至患者不能耐受或最大剂量不超过400mg／d,28天为1周期,连续治疗5周期后观察其疗效及副作用。结果治疗后总有效率达86．7％、部分缓解66．7％、进步20％;主要副作用：乏力、恶心、呕吐,中性粒细胞减少,个别患者心功能衰竭。结论三氧化二砷联合反应停治疗难治或复发性骨髓瘤具有良好的疗效。     

小剂量反应停联合地塞米松治疗难治性多发性骨髓瘤的临床疗效观察

目的：观察小剂量反应停联合地塞米松对难治性多发性骨髓瘤的疗效。方法：小剂量反应停联合地塞米松治疗难治性多发性骨髓瘤23例,治疗方法用反应停起始剂量100mg/d,2周后加量至200mg/d,每天分2次口服,地塞米松1.5mg/d,每天分2次口服,二药联合应用,持续3个月,3个月后进行化疗1个疗程,3个月为1个周期。结果：2个周期治疗后部分缓解7例,进步9例,无效7例,总有效率为70%。结论：小剂量反应停联合地塞米松治疗难治性多发性骨髓瘤疗效确切,不良反应少。     

小剂量反应停联合VCMP方案用于初治的多发性骨髓瘤20例疗效观察

多发性骨髓瘤（MM）是浆细胞克隆性增殖的恶性肿瘤。其特征是骨髓中浆细胞克隆性增殖并积聚，并分泌单克隆的免疫球蛋白或其片段（M蛋白），同时伴有广泛的溶骨性病变或骨质疏松及贫血、感染、肾功能损害等临床表现。其治疗效果差，完全缓解率低于5%，存活10年的MM不到5％。改良的M2方案，如VCMP方案，对其治疗的有效率为50％左右。从20世纪90年代以来，反应停用于治疗多发性骨髓瘤，取得了较好的疗效。但大剂量应用，其临床副反应大，患者难以承受。我院近年来采用小剂量反应停联合VCMP方案，治疗初治的多发性骨髓瘤29例，取得了较好的疗效，取其完整的病例20例，现报告如下。     

反应停联合地塞米松治疗多发性骨髓瘤临床观察

目的　观察反应停治疗多发性骨髓瘤 (multiplemyelomaMM)的疗效及不良反应。方法　反应停剂量为15 0 -4 0 0mg d ,地塞米松 2 0 -4 0mg d ,d1-4 ,d9-12 ,d17-2 0。根据M蛋白及骨髓中骨髓瘤细胞的减少情况来判断疗效 ,同时观察血象、肾功能、X线等变化。结果　反应停联合糖皮质激素治疗 9例患者 4例部分缓解 ,2例进步 ,2例无效。总有效率达 66.7%,其中 ,难治性MM有效率达 60 .0 %。大多数患者有轻中度副反应 ,一般能耐受 ,外周血三系大多数无明显下降。结论　反应停联合糖皮质激素治疗多发性骨髓瘤是不良反应轻且有效的方法     

反应停治疗难治性复发性多发性骨髓瘤疗效分析

目的探讨反应停治疗难治性复发性多发性骨髓瘤(MM)的疗效和不良反应。方法对18例难治性复发性MM应用反应停治疗后的临床资料分析,并结合文献,以寻找难治性复发性MM的治疗方案。结果完全缓解1例,部分缓解2例,进步9例,无效6例,总有效率达66.7%,大多数患者有轻度不良反应,可以耐受。结论反应停对难治性复发性MM有较好疗效,无不能耐受的不良反应。     

低剂量反应停联合地塞米松治疗难治性多发性骨髓瘤的临床观察

目的观察低剂量反应停联合地塞米松治疗难治性多发性骨髓瘤的临床疗效.方法10例难治性复发性多发性骨髓瘤患者,反应停起始剂量100mg/d,每周增加50mg,2周后增至200mg/d,至少服用3个月,同时联合地塞米松.结果部分缓解(PR)5例,进步2例,无效3例;不良反应可耐受,轻度便秘多见.结论低剂量反应停(200mg/d)联合地塞米松治疗难治性多发性骨髓瘤安全有效.     

亚砷酸联合反应停、维生素C治疗难治性复发性多发性骨髓瘤疗效观察

目的：探讨亚砷酸联合反应停、维生素C治疗难治性复发性多发性骨髓瘤的临床疗效。方法：选取2003年3月-2013年4月本院收治的84例多发性骨髓瘤患者作为观察对象,随机分为治疗组43例和对照组41例,对照组采用常规疗法MP方案（马法兰＋泼尼松）,治疗组采用亚砷酸联合反应停、维生素C综合疗法,比较两组总有效率,并分别于治疗前后观察血象、骨髓象、肾功能、血清单克隆免疫球蛋白、血沉等指标,对比治疗前后各项指标的变化。结果：治疗组临床总有效率为83.7%,明显优于对照组的58.1%（P〈0.05）;且治疗组血象、骨髓象、肾功能、血清单克隆免疫球蛋白、血沉等指标改善明显优于对照组（P〈0.05）。结论：亚砷酸联合反应停、维生素C治疗难治性复发性多发性骨髓瘤患者疗效显著,能提高患者生活质量,值得临床推广应用。     

Bendamustine in patients with relapsed or refractory multiple myeloma

Objective

In patients with multiple myeloma, bendamustine monotherapy is effective as 1^st and 2^nd line therapy. However, data for patients with advanced multiple myeloma is rare.

Methods

In this retrospective analysis we have identified 39 patients with relapsed or refractory multiple myeloma by means of case research, who have been treated at our institution with bendamustine as salvage therapy. After in median 2 lines of prior therapy (range:1-5) patients received in median 3 (range: 1-10) cycles of bendamustine. Bendamustine dosage was 80-150 mg on day 1+2 of a monthly cycle. Bendamustine was administered as monotherapy in 39% of patients, whereas 61% received concomitant steroids.

Results

Toxicity was mild to moderate. Response rates were as follows: 3% vgPR, 33% PR, 18% MR, 26% SD and 20% PD. The median event-free and overall survival were 7 and 17 months, respectively.

Conclusions

In conclusion, in patients with advanced multiple myeloma bendamustine is effective and associated with mild toxicity. Therefore, the role of bendamustine in patients with multiple myeloma should be investigated in further clinical trials.     

Response of vincristine, melphalan, cyclophosphamide and prednisolone in refractory multiple myeloma

In refractory and relapsing multiple, myeloma good complete response rates may be achieved by Vincristine, Melphalan, Cyclophosphamide and Prednisolone (VMCP) like regimen which is effective alternative and less expensive in developing country like Bangladesh. The study was conducted to see the response of VMCP as an alternative in relapsing or refractory multiple myeloma. The study has been carried out in the department of Haematology, Bangabandhu Sheikh Mujib Medical University from July 2004 to June, 2005. This study was conducted on refractory case of multiple myeloma, having aged between 45 to 70 years. A total of ten patients had been taken for this study group. Newly diagnosed multiple myeloma is not included in this study. All of the 10 patients were treated according to the following VMCP protocol, Vincristine 1mg IV, d1, Melphalan 6mg/m2/d p.o. d1-d7, Cyclophosphamide 120mg/m2/d p.o. d1-d7 Prednisolone 60mg/m2/d p.o. d1-d7. Cycles were repeated every 28 days for 6 cycle. Six out of ten patients with refractory multiple myeloma displayed minimal response (60%) after treatment with 6 cycle of VMCP protocol, three patients entered partial remission (30%), and one (10%) showed complete response.     

AAE方案联合环孢霉素A治疗难治性急性非淋巴细胞白血病

目的探讨难治性急性非淋巴细胞白血病(ANLL)的有效治疗方法。方法22例难治性ANLL采用阿糖胞苷(Ara-C)、安吖啶(AMSA)和依托泊苷(VP16)组成的AAE方案联合反转耐药剂环孢霉素A(CsA)治疗,7d为1个疗程,疗程结束3周后评价疗效,并观察不良反应发生情况。结果22例患者中,完全缓解13例,完全缓解率为59.1%,部分缓解4例,部分缓解率为18.2%,总有效率77.3%。完全缓解的13例患者中,1个疗程缓解9例(69.2%),2个疗程缓解3例(23.1%),3个疗程缓解1例(7.7%)。22例中发生骨髓抑制12例(54.5%),合并严重感染7例(31.8%),口腔溃疡11例(50.0%)。结论AAE方案联合CsA治疗难治性ANLL有一定的效果。     

免疫固定电泳技术在多发性骨髓瘤诊断及分型中的应用

[目的]探讨免疫固定电泳技术在多发性骨髓瘤(MM)诊断及分型中的应用.[方法]收集30例患有MM的患者的血清进行相关检测.免疫固定电泳采用美国海伦那电泳仪进行检测及扫描;免疫球蛋白定量及血轻链检测:用西门子BNⅡ免疫分析仪以全自动方式进行速率散射比浊分析对MM患者的血清中免疫球蛋白(IgG、IgA、IgM)含量及血轻链...     

万珂在治疗多发性骨髓瘤中的临床应用

目的:观察蛋白酶体抑制剂硼替佐米(万珂)为主的化疗方案治疗多发性骨髓瘤(MM)的疗效和不良反应。方法:多发性骨髓瘤患者接受含有万珂的联合方案进行化疗。按照EBMT/ABMT标准进行疗效评定。结果:在接受万珂治疗的18例患者中,初治10例,复发难治8例;总有效率达83%,其中完全缓解(CR)3例,接近完全缓解(nCR)5例,部分缓解(PR)7例,死亡3例。主要不良反应包括周围神经病变、血小板减少、胃肠道反应以及病毒感染,经对症处理后好转,一般不影响治疗。结论:万珂对于初治和复发难治的多发性骨髓瘤是一种比较安全有效的治疗药物,起效较快,治疗反应率及完全缓解率较高。     

Primary Sjogren''''s syndrome and its lymphoid malignancy: a report of four cases

Objective To evaluate the incidence and spectrum of malignancy of primary Sjogren's syndrome (pSS).Methods 250 pSS who were followed-up in Peking Union Medical College (PUMC) Hospital were analyzed.Results Four of them were diagnosed with histopathological findings of 2 non-Hodgkin Lymphoma, 1 AILD, 1 multiple myeloma. Two died of secondary infection while receiving chemotherapy for lymphoma, 2 remained remitted.Conclusions The risk factors were persistent enlargement of major salivary glands, appearance of monoclonal serum Ig, and disappearance of auto antibodies.     

肾复康治疗肾病综合征的临床研究

为观察肾复康（由雷公藤、黄芪、三七、益母草、山茱萸、茵陈等中药组成）对原发性肾病综合征的临床疗效、副作用,采用前瞻性随机对照方法,观察肾复康对肾病综合征患者（７０例）２４ｈ尿蛋白定量、血清白蛋白、胆固醇、肌酐和尿素氮等的影响,以及不同中医证型疗效的差别,并与３０例雷公藤多甙对照组进行比较。结果：肾复康组完全缓解１６例（１４．３％）吸效２８例（４０％）,无效１６例（３６．７％）,总有效率为７７．１％     

Melphalan and dexamethasone for patients with multiple myeloma who are not candidates for autologous stem cell transplantation

BACKGROUND: Multiple myeloma is a disease for which a number of treatment options are available. The choice of therapy is often based on factors such as cost, ease of administration and faster response as the survival rates are similar with most of the regimens. We assessed the efficacy of a combination of melphalan and dexamethasone as first-line therapy in patients with multiple myeloma who were not candidates for autologous stem cell transplantation. METHODS: Thirty-four patients with multiple myeloma were included in the study. Patients received a maximum of 12 cycles of chemotherapy consisting of oral melphalan 8 mg/m2 on days 1-4 and oral dexamethasone 40 mg on days 1-4 and days 9-12 every 4 weeks. Patients were assessed for response on the basis of M proteins and a bone marrow biopsy with touch preparation. RESULTS: The median follow up of surviving patients was 40 months. Nine patients (26.1%) had complete response/near complete response (5 had negative immunofixation) and 15 (44%) had partial response. The regimen was well tolerated and there were no therapy-related deaths. The 3-year overall and progression-free survival rates using the Kaplan-Meier method were 53% and 34%, respectively. The median duration of overall and progression-free survivals were 58 and 28 months, respectively. CONCLUSION: The combination of melphalan and dexamethasone is safe and effective in patients with multiple myeloma who are not candidates for autologous stem cell transplantation.     

基于大剂量地塞米松的化疗方案治疗合并肾功能不全的初治多发性骨髓瘤的疗效和安全性

目的 评估基于大剂量地塞米松的化疗方案治疗合并肾功能不全的初治多发性骨髓瘤患者的疗效和安全性.方法 回顾性分析2006年8月～2008年8月在北京协和医院接受基于大剂量地塞米松化疗方案治疗的22例合并肾功能不全的初治多发性骨髓瘤患者的临床资料.结果 在接受中位4个疗程基于大剂量地塞米松的化疗方案后,22例患者中,有7例(31.8%)肾功能恢复,中位至恢复时间为31 d;16例(72.7%)有效,其中7例(31.8%)完全或接近完全缓解.3～4级副作用包括粒细胞减少(13.6%)、感染(22.7%)、周围神经病变(9.1%)和肠梗阻(4.5%).结论 基于大剂量地塞米松的化疗方案可以安全、有效地治疗合并肾功能不全的初治多发性骨髓瘤患者.     

多发性骨髓瘤的临床及影像学分析

目的：探讨多发性骨髓瘤的临床表现特征与影像学的诊断价值．方法：回顾性分析32例经骨髓穿刺或手术病理证实的MM患者的影像学资料，对其临床特征和影像学表现特点进行综合分析．结果：多发性骨髓瘤最常见的临床表现有全身性疼痛、贫血、出血、肾功能损害、发热、肺部感染和全身乏力等．32例患者不同部位X线摄片的阳性率分别为颅骨85％、肋骨56％、脊椎53％、肩胛骨46．1％、骨盆43％、股骨37．5％、胫骨33．3％。15例脊椎CT均显示明显骨质破坏。12例脊椎MRI中有10例示明显信号改变。18例ECT全身骨扫描全部出现多骨的浓聚灶．结论：多发性骨髓瘤起病隐匿。临床表现多样化且缺乏特征性。典型影像学表现为多发穿凿状或虫蚀状骨质破坏及广泛的骨质疏松；X线平片检查尤其是头颅、骨盆、腰椎、肋骨及骨痛部位。应作为多发性骨髓瘤初诊的常规筛查，CT、MRI及ECT检查对早期和不典型多发骨髓瘤病变的显示明显优于X线平片检查．