硼替佐米联合化疗与常规化疗方案治疗多发性骨髓瘤的临床比较

目的 观察硼替佐米联合地塞米松及沙利度胺BDT(Velcade+ Daxamethasone+ Thalidomide)方案与改良VAD(Vinorebine+Pirarubicin+Daxamethasone)方案、MPT(Melphalan+ Prednisone+ Thalidomide)治疗初发或复发/难治性多发性骨髓瘤患者的疗效及不良反应.方法 52例多发性骨髓瘤(MM)患者均为Durie-Salmon分期Ⅲ期,其中初治45例,复发/难治7例.21例(16例初治,5例复发/难治)MM患者采用BDT方案治疗,19例(18例初治,1例复发/难治)MM患者采用改良VAD方案治疗,12例(11例初治,1例复发/难治)MM患者采用MPT方案治疗.临床疗效根据EBMT/IBMTR/ABMTR标准判定,不良反应按依据NCICTCAE标准判断.结果 BDT方案组患者骨痛症状明显消失,贫血及肾功能不全得到明显改善,甚至恢复正常,21例患者中14例(66.7%)完全缓解(CR),6例(28.6%)部分缓解(PR),1例(4.8%)无变化(NC),总有效率为95.2%;改良VAD方案组19例患者中5例(26.3%)CR,3例(15.8%)PR,5例(26.3%)微小缓解(MR),2例(10.5%)NC,4例(21.0%)疾病进展(PD),总有效率为68.4%;MPT方案组12例患者中1例(8.3%)CR,2例(16.7%)PR,2例(16.7%)MR,1例(8.3%)NC,6例(50.0%)PD,总有效率为50.0%;三组间疗效比较差异有统计学意义(P<0.05).出现的不良反应包括血液学毒性和非血液学毒性.BDT组所有不良反应均在对症处理或停药后缓解或减轻.结论硼替佐米联合地塞米松及沙利度胺是一种新的有效治疗多发性骨髓瘤的化疗方案,不良反应轻且大多可逆,患者具有较好的耐受性.

Clinical comparison analysis of the treatment regimens of bortezomib in combination with chemotherapy with conventional chemotherapy for patients with multiple myeloma

Objective To investigate the efficacy and adverse reactions in the treatment of patients with early or recurrent/refractory multiple myeloma by different regimens including bortezomib in combination with dexamethasone and thalidomide(Velcade + Daxamethasone + Thalidomide),improved VAD(Vinorebine + Pirarubicin + Daxamethasone),MPT(Melphalan + Prednisone + Thalidomide).Methods Among fifty-two patients with multiple myeloma(MM) of Durie-Salmon stage Ⅲ,45 cases were initial treated,7 cases were relapsed/refractory.Twenty-one cases(16 cases were initial treated,5 cases were relapsed/refractory) were treated with BDT,and 19 cases(18 were initial treated,1 case was relapsed/refractory) with modified VAD,12 cases(11 were initial treated,1 case was relapsed/refractory) with MPT.Clinical efficacies were determined according to EBMT/IBMTR/ABMTR standard,adverse reactions were based on NCICTCAE standard.Results Among the 21 patients treated with BDT,bone pain were disappeared,anemia and renal dysfunction were significantly improved or even become normal,CR,PR,and NC were 14 cases(66.7%),6 cases(28.6%),1 cases(4.8%) respectively,total efficiency was 95.2%;Among the 19 patients in improved VAD group,CR,PR,MR,NC and PD were 5 cases(26.3%),3 cases(15.8%),5 cases(26.3%),2 cases(10.5%),and 4 cases(21.0%) respectively,total efficiency was 68.4%;Among the 12 cases treated with MPT,CR,PR,MR,NC and PD were 1 case(8.3%),2 cases(16.7%),2 cases(16.7%),1 case(8.3%),6 cases(50.0%) respectively,total efficiency was 50.0%.There was significant difference in efficacy among the three groups(P<0.05).The adverse reactions were hematologic toxicity and non-hematologic toxicity.In BDT group,all adverse reactions were remission or reduction after treatment.Conclusion The chemotherapy regimen of bortezomib in combination with dexamethasone and thalidomide is a new and effective treatment for multiple myeloma,side effects were light and mostly reversible and patients have good tolerability for it.