三氧化二砷联合化疗治疗多发性骨髓瘤30例的临床观察

目的探讨三氧化二砷联合化疗治疗多发性骨髓瘤（MM）的疗效。方法回顾性分析2010年1月至2013年6月本院血液科收治的MM患者30例的临床资料，所有患者采用三氧化二砷与联合化疗交替进行治疗，每次化疗间隔21d。以三氧化二砷和VAD方案或COMP方案联合化疗交替治疗完成为1个治疗周期，所有患者治疗4～6个周期，治疗期及间隔期均服用沙利度胺。所有患者治疗前及治疗后检测血清M蛋白、肌酐、β2微球蛋白和血红蛋白水平，并进行骨髓细胞学检查。治疗结束后评价其疗效和不良反应。结果治疗结束后30例患者疗效评价显示，严格的完全缓解1例、完全缓解5例、很好的部分缓解8例、部分缓解10例、病情稳定3例、病情进展3例（其中1例患者死亡），总有效率为80．0％（24／30）。与治疗前比较，患者治疗后骨髓浆细胞比例、血清M蛋白、肌酐、β2微球蛋白水平下降，血红蛋白水平升高（均P〈0．05）。应用三氧化二砷治疗时，患者不良反应轻微，对症治疗后均好转。结论三氧化二砷联合化疗治疗IN的疗效和安全性较好。

Clinical observation of 30 multiple myeloma patients treated with combination of arsenic trioxide and chemotherapy

Objective To evaluate the efficacy of arsenic trioxide combined with chemotherapy in treating multiple myeloma （MM） patients. Methods A retrospective analysis was performed on the clinical data of 30 MM patients registered to hematology department of our hospital between January 2010 and June 2013. The patients were alternately treated with arsenic trioxide and VAD or COMP chemotherapy at 21-day intervals. A treatment cycle was defined as a completion of treatment with arsenic trioxide and VAD or COMP chemotherapy. All the patients were treated for 4 to 6 cycles. Thalidomide was taken in both treatment period and interval period. The serum levels of M protein, creatinine,β2-microglobulin and hemoglobin of all patients were tested before and after treatment. Besides, bone marrow cytology was studied. The efficacy and adverse reactions were evaluated after treatment. Results After completion of the treatments, efficacy evaluation of 30 patients showed that there was one case of strictly complete remission, 5 of complete remission, 8 of very good partial remission, 10 of partial remission, 3 of stable disease and 3 of disease progression （including one dead case）. The overall response rate （ORR） was 80.0% （24/30）, Compared with pretreatment, the proportion of bone marrow plasma cells and the serum levels of M protein, creatinine and β2-microglobulin in patients were decreased after the treatments, accompanied with the increased levels of hemoglobin （all P〈0.05）. When the patients were treated with arsenic trioxide, adverse reactions in patients were mild and resolved after symptomatic treatment. Conclusion The efficacy and safety of arsenic trioxide combined with chemotherapy in treatment of MM patients are reliable.