BDT和VADT方案治疗多发性骨髓瘤的临床研究

目的比较BDT与VADT方案治疗多发性骨髓瘤（MM）的疗效及不良反应。方法回顾分析72例MM病人,其中24例病人（初治13例,复发难治11例）接受BDT（硼替佐米联合地塞米松、沙利度胺）方案治疗,48例病人（初治36例,复发难治12例）接受VADT（长春地辛联合表柔比星、地塞米松、沙利度胺）方案化疗。所有病人均接受4～6个疗程治疗后进行全面评价,自动放弃治疗、疗程不符合标准以及失访病人不计入。结果 BDT组和VADT组的总完全缓解（TR）率分别为68.42%和35.42%,初治病人TR率分别为80.00%、44.44%,复发难治病人TR率分别为55.56%、8.33%,两组比较差异均有显著性（2χ=3.965～5.996,P〈0.05）;两组的总体有效（RR）率分别为89.47%和70.83%,两组比较差异无显著性（P〉0.05）。两组初治病人达到最大反应中位疗程数分别为3和5个,复发难治病人分别为4和7个。常见的不良反应有骨髓抑制、消化道症状、肝肾功能损害、周围神经病变、乏力、血栓形成、血凝异常、带状疱疹病毒感染、精神症状、皮疹等,两组比较差异无显著意义（P〉0.05）。结论 BDT方案治疗MM比VADT方案有较高的TR率,对复发难治性MM效果明确,且起效更快,副作用多可耐受,值得临床推广。

CLINICAL STUDY OF BDT AND VADT REGIMEN IN THE THERAPY OF MULTIPLE MYELOMA

Objective To compare the efficacy and adverse effects of bortezomib-dexamethasone-thalidomide（BDT） regimen with vincristine-epirubicin-dexamethasone-thalidomide（VEDT） regimen for multiple myeloma（MM）. Methods A retrospective analysis was done in 72 MM patients,of whom,24（initial treatment 13 cases;recurrent and refractory 11） received BDT regimen;48（initial treatment 36;recurrent and refractory 12） treated with VEDT.All the patients were appraised after 4-6 courses of therapy,those who gave up the treatment,their course did not meet the criteria,and those failed to be followed were excluded from this study. Results The total complete remission rate（TR） of BDT and VEDT was 68.42% vs.35.42%;that of initial patients was 80.00% vs.44.44%;that of recurrent and refractory 55.56% vs.8.33%,the differences being significant between the two groups（χ2=3.965-5.996,P0.05）.The total effective power was 89.47% for BDT,and 70.83% for VADT,with no significant difference between the two groups（P0.05）.In BDT group,the new patients required three median cycles to reach the best response and in VEDT,five cycles were needed;for recurrent /refractory,three vs.five.Common adverse reactions of the two therapy programs were not significantly different,which included bone marrow depression,alimentary tract symptoms,damage of liver or renal function,peripheral neuropathy,fatigue,thrombosis,dysfunction of blood coagulation,herpes zoster,mental symptoms and rash. Conclusion BDT has a higher TR rate than VEAT in the treatment of MM,the efficacy is definite and rapid onset,the side effects are tolerable.BDT therapy is worth clinical generalization.