硼替佐米为主方案治疗复发难治性多发性骨髓瘤

 目的 探讨硼替佐米联合地塞米松等治疗复发难治性多发性骨髓瘤（MM）的疗效及毒副作用。方法 5例复发难治的MM采用硼替佐米1.1 ~ 1.3 mg／m2，联合地塞米松30 mg ~ 40 mg，第1、4、8、11天；沙利度胺100 ~ 200 mg，第1天至第21天，第4天加或不加表柔比星，3周为1个疗程，每位患者治疗1 ~ 4个疗程。根据欧洲血液病和骨髓移植组（EBMT）标准判断疗效、WHO抗癌药毒副作用的分度标准判断不良反应。结果 5例患者均有效，疗效出现在治疗3周后，1个疗程近似完全缓解（CR）2例，轻微有效（MR）2例，另1例3个疗程后达部分缓解（PR）。患者不良反应主要是贫血、白细胞和血小板减少，其减少的程度和治疗前水平相关，其次为腹泻、末梢神经炎和乏力，经对症处理缓解。结论 硼替佐米联合地塞米松等能有效治疗复发难治性MM，耐受性良好。

The bortezomib treatment relapse and refractory multiple myeloma

Objective To evaluate the effect of bortezomib with dexamethasone and other drugs to treat relapsed and refractory multiple myeloma. Methods Five patients with relapse and refractory multiple myeloma recieve bortezomib 1.1~1.3mg/m2 iv d1,4,8,11, dexamethasone 30~40 mg, d1, 4, 8, 11, thalidomide 100~200 mg d1~d21, with or without pirarubicin 40mg-80mg d4,every 3 weeks.Every patient received the treatment for 1~4 cycles. Results Response to bortezomib was evaluated according to the criteria of the Eu－ropean Group for Blood Marrow Transplantation (EBMT). Adverse events were graded according to the criteria of the World Health Organization about the anticancer drugs toxicity. All patients have response. Responses occurred after 3 weeks of the treatment. After 1 cycles treatment two patients achieved a near complete re－sponse and two a minor respones. Another patients had a partial response after three cycles treatment. Adverse events were mainly anemia, leucocytopenia and thrombocytopenia. The degree of peripheral blood cell reduc－tion was correlated to the level of pretherapy. Another side effect such as diarrhea, neuropathy and fatigue were manageable. Conclusion Bortezomib combined with dexamethasone and other drugs are effective for treatment relapse and refractory multiple myeloma.