硼替佐米为主的联合方案治疗多发性骨髓瘤的临床观察

目的观察硼替佐米为主的联合方案治疗多发性骨髓瘤的疗效和安全性。方法多发性骨髓瘤患者15例,其中初治患者9例,复发难治者6例,采用至少2个疗程的硼替佐米(1.3 mg/m2,第l、4、8、11天),同时联合沙利度胺(100～200 mg/d)及地塞米松(20～40 mg/d,第1～4、8～11天)治疗,21 d为1个疗程。疗效判断参照国际骨髓瘤工作组(IMWG)标准,化疗相关不良反应参照WHO标准分级。结果 9例初治患者达完全缓解CR 3例(33.3%),非常好的部分缓解VGPR 4例(44.4%),部分缓解PR 2例(22.2%),总有效率为100%;6例复发难治患者达CR 1例(16.7%),VGPR 1例(16.7%),PR 2例(33.3%),疾病稳定(SD)1例(16.7%),疾病进展(PD)1例(16.7%),总有效率为83.3%。常见不良反应包括血小板下降10例(66.7%),白细胞减少7例(46.7%),胃肠道反应8例(53.3%),周围神经病变6例(40%),严重带状疱疹1例(0.07%),低血压1例(0.07%),经治疗均可耐受。结论硼替佐米为主的联合方案治疗初治及复发难治多发性骨髓瘤患者具有有效率高、耐受性好等优点,为多发性骨髓瘤患者治疗提供了一种全新的治疗方法。

Bortezomib-based combination therapy for multiple myeloma

Objective To observe the curative effect and safety of bortezomib based combination therapy for patients with de novo and refractory or relapsed multiple myeloma. Methods Fifteen patients with multiple myeloma （9 cases of de novo multi- ple myeloma and 6 cases of refractory or relapsed multiple myeloma） were treated with bortezomib（ 1.3 mg/m2, on the 1 st, 4th, 8th and llth day） for at least 2 courses （21 days as a course） , in combination with thalidomide（ 100 -200 rag/d） and dexam- ethasone（20 - 40 rag/d, dl - d4, d8 -dl 1 ）. Effects were evaluated according to the criteria of EBMT for multiple myeloma, ad- verse events were graded according to the criteria of WHO. Results In the 9 patients with de novo multiple myeloma, the over- all response rate achieved 100%, including CR in 3 patients （33.3%）, VGPR in 4 patients （44. 4% ） and PR in 2 patients （22. 2% ） ; in the 6 patients with refractory or relapsed multiple myeloma, the overall response rate achieved 83.3% , including CR in 1 patient （ 16.7% ）, VGPR in 1 patient （ 16.7% ）, PR in 2 patients（33.3% ）, SD in 1 patient （ 16.7% ） and PD in 1 patient （ 16. 7% ）. The frequent adverse events were thrombocytopenia （66. 7% ）, leucocytopenia（46.7% ）, nause（53.3% ）, peripheral neuropathy （ 40% ）, herpes zoster （ 0. 07% ） and hypotension （ 0. 07% ） ; all of the events could be tolerated. Conclusion Bortezomib based combination therapy is a new effective and safe therapy in de novo and refractory or relapsed mul- tiple mveloma.