PAD与T-VAD方案治疗初治多发性骨髓瘤的疗效与安全性分析

目的：探讨PAD方案（硼替佐米、阿霉素和地塞米松）与T-VAD方案（沙利度胺联合长春地辛、阿霉素、地塞米松）治疗初治多发性骨髓瘤的疗效与安全性.方法：回顾分析47例初治多发性骨髓瘤患者的治疗情况,其中PAD治疗组23例,T-VAD治疗组24例.结果：PAD治疗组总有效率91.3％（21/23）,其中完全缓解（complete response,CR）8例（34.8％）,很好的部分缓解（very good partial response,VGPR）3例（13.0％）,部分缓解（partial response,PR）10例（43.5％）,疾病稳定（stable disease,SD）2例（8.7％）.T-VAD治疗组总有效率66.7％（16/24）,其中CR 4例（16.7％）,VGPR 2例（8.3％）,PR 10例（41.7％）,SD 5例（20.8％）,疾病进展（progressive disease,PD）3例（12.5％）.2组疗效比较差异有统计学意义（P＜0.05）.PAD组的不良反应为：便秘5例（21.7％）,腹泻4例（17.4％）,恶心3例（13.0％）;中性粒细胞减少3例（13.0％）,贫血2例（8.7％）,血小板下降2例（8.7％）;乏力2例（8.7％）;带状疱疹6例（26.1％）;周围神经病变5例（21.7％）.T-VAD组患者均有便秘（100％）,嗜睡1 5例（62.5％）,皮疹2例（8.3％）,带状疱疹1例（4.2％）,下肢水肿2例（8.3％）,深静脉血栓1例（4.2％）.2组患者均未发生严重的不良反应.结论：PAD和T-VAD方案均具有良好的安全性,而PAD方案对初治多发性骨髓瘤的疗效较好.

Efficacy and Safety of PAD and VAD Combined with Thalidomide in the Treatment of Newly Diagnosed Multiple Myeloma

Objective：To study the efficacy and safety of PAD regimen（bortezomib ＋ adriamycin ＋ dexamethasone） and T-VAD regimen（vindesine ＋ adriamycin ＋ dexamethasone ＋ thalidomide） in the treatment of newly diagnosed multiple myeloma （MM）.Methods：A total of 47 patients with newly diagnosed MM were involved.Twenty-three patients were treated with PAD regimen.Twenty-four patients were treated with T-VAD regimen.Results：The overall response rate with PAD regimen was 91.3％（21/23）,with complete response（CR） in 8 cases（34.8％）,very good partial response（VGPR） in 3 cases（13.0％）,partial response（PR） in 10 cases（43.5 ％）,stable disease（SD） in 2 cases（8.7 ％）.The overall response rate with T-VAD regimen was 66.7％（16/24）,with CR in 4 cases（16.7％）,VGPR in 2 cases（8.3％）,PR in 10 cases（41.7％）,SD in 5 cases （20.8％）,progressive disease（PD） in 3 cases（12.5 ％）.There was significant difference in efficacy between the two groups（P＜0.05）.The adverse events with PAD regimen included constipation in 5 cases（21.7 ％）,diarrhea in 4 cases（17.4 ％）,nausea in 3 cases （13.0 ％）,neutropenia in 3 cases （13.0 ％）,anemia in 2 cases （8.7 ％）,thrombocytopenia in 2 cases （8.7 ％）,weak in 2 cases （8.7 ％）,herpes zoster in 6 cases（26.1％）,peripheral neuropathy in 5 cases（21.7％）.The adverse events with T-VAD regimen included constipation in 24 cases（100％）,somnolence in 15 cases（62.5％）,rash in 2 cases（8.3％）,herpes zoster in 1 case （4.2 ％）,edema of lower extremity in 2 cases（8.3 ％）,deep venous thrombosis in 1 case（4.2 ％）.No severe side effects were observed in both therapies.Conclusions：Both therapies are safe,and PAD is more effective than T-VAD regimen for patients with newly diagnosed MM.