减低剂量及标准剂量硼替佐米联合疗法对不同类型多发性骨髓瘤的近期疗效对比

目的 探讨减低剂量及标准剂量硼替佐米联合阿霉素、地塞米松治疗不同类型多发性骨髓瘤（MM）的近期疗效及安全性.方法 对52例初诊、复发及难治MM患者给予硼替佐米1.3 mg/m2（标准剂量组,26例）或1.0～1.1 mg/m2（减低剂量组,26例）,第1,4,8,11天快速静脉注射,阿霉素10 mg/m2,第1～4天静脉注射,地塞米松40mg/d,第1～4天静脉滴注,治疗1～6个疗程.比较两组患者的疗效和不良反应.结果 标准剂量组治疗总反应率为80.8％（21/26）,与减低剂量组的88.5％（23/26）比较差异无统计学意义（P=0.739）;两组白细胞、血小板减少发生率比较差异均无统计学意义[23.1％（6/26）比15.4％（4/26）,P=0.281;11.5％（3/26）比7.7％（2/26）,P=0.620];标准剂量组与减低剂量组比较,由硼替佐米诱导的Ⅲ～Ⅳ级周围神经病[15.4％（4/26）比3.8％（1/26）,P=0.038）]、带状疱疹[26.9％（7/26）比7.7％（2/26）,P=0.029]、乏力[38.5％（10/26）比15.4％（4/26）,P=0.045]及腹胀发生率[19.2％（5/26）比3.8％（1/26）,P=0.028]前者均高于后者,差异有统计学意义.结论 减低剂量联合疗法治疗初诊和复发、难治MM患者的疗效反应与标准剂量类似,但患者对减低剂量联合方案具有更好的耐受性.

Efficacy comparison between standard and reduced doses of bortezomib combination therapy in the treatment of multiple myeloma

Objective To compare the efficacy and safety of standard or reduced doses of bortezomib combined with adriamycin and dexamethasone in patients with multiple myeloma （MM）.Methods Fifty-two newly diagnosed,refractory and relapsed patients received bortezomib [1.3 mg/m2 （standard dose group,26 patients） or 1.0-1.1 mg/m2 （reduced dose group,26 patients） on day 1st,4th,8th and 11 th],and adriamycin （10 mg/m2） plus dexamethasone （40 mg/d） on day 1 st-4th,and were treated for 1-6 courses.Adverse events were graded and compared.Results After treatment,the overall response rate of standard dose group [80.8%（21/26）] and reduced dose group [88.5%（23/26）] had no significant difference （P =0.739）.The rate of neutropenia and thrombocytopenia in two groups had no significant difference[23.1%（6/26） vs.15.4%（4/26）,P=0.281 ; 11.5%（3/26） vs.7.7%（2/26）,P=0.620].The rate of Ⅲ-Ⅳ grade peripheral nerve disease,herpes zoster,lack of power and abdominal distension in standard dose group were significantly higher than those in reduced dose group [15.4%（4/26） vs.3.8%（1/26）,P =0.038;26.9%（7/26） vs.7.7%（2/26）,P =0.029;38.5%（10/26） vs.15.4%（4/26）,P=0.045; 19.2%（5/26）vs.3.8% （1/26）,P =0.028].Conclusion Reduced dose of bortezomib appears to result in similar overall response rate,but better tolerance and safety compared with standard dose.