206例多发性骨髓瘤患者不同方案疗效分析

目的　探讨不同化疗方案对多发性骨髓瘤(MM)患者的治疗效果。方法　回顾性分析了206例MM患者的治疗情况,对不同治疗方案的疗效进行比较。结果　200例药物治疗患者的中位生存期为30. 5个月, 3年和5年实际生存率分别为32. 01%和15. 8%。195例行常规化疗患者的总有效率为45. 6%,其中完全缓解率14. 9% (29例),部分缓解率30. 8% ( 60例)。联合化疗组的总有效率为50. 3%,明显高于MP(马法兰和泼尼松)方案组的总有效率(30. 4% ) (P<0. 05);这两组的中位生存期分别为30. 5个月和30. 0个月、3年和5年生存率分别为35. 0%和22. 0%, 16. 7%和13. 2%,差异无统计学意义(P值均>0. 05)。合并干扰素治疗组的有效率为53. 6% ,中位生存期52. 0个月,与未用干扰素治疗组(分别为34. 4%, 27. 0个月)相比,有效率提高(P<0. 05)、生存期延长(P<0. 01)。合并沙利度胺治疗的总有效率为65. 5%。6例外周血造血干细胞移植患者有5例存活,平均生存期为(73. 0±12. 5)个月。结论　联合化疗的有效率高于MP方案,但两组的总生存率差异无统计学意义。干扰素能使化疗有效率增加,中位生存期延长。沙利度胺也能够提高MM患者的治疗有效率。对于年龄较轻、一般状态较好的患者,自体干细胞移植可明显提高生存期。

The outcome analysis of different treatment regimens in 206 patients with multiple myeloma

OBJECTIVE: To analyse the outcome of different regimens for the treatment of patients with multiple myeloma (MM). METHODS: Response rate, median survival time and overall survival rate of 206 MM patients treated with different protocols were retrospectively analysed. RESULT: The median survival time, 3- and 5-year overall survival (OS) of 200 MM patients treated with conventional therapy were 30.5 months, 32.0% and 15.8%, respectively. The total response rate and complete response (CR) rate of 195 patients treated with MP regimen and combination chemotherapy (CCT) were 45.6% and 14.9%, respectively. The response rates were higher for the patients treated with CCT than for those treated with MP (50.3% versus 30.4%, P < 0.05). The median survival time, 3- and 5- year OS in MP versus CCT group were 30.0 versus 30.5 months, 22.0% versus 35.0%, 13.2% versus 16.7%, respectively, but all of them have no statistical difference. Compared with those without IFNalpha maintenance therapy, patients received IFNalpha therapy showed a higher response rate (34.4% versus 53.6%, P < 0.05) and a longer median survival time (27 versus 52 months, P < 0.01). The total response in patients received thalidomide was 65.5%. Of the 6 patients received hematopoietic stem cell transplantation (HSCT), 5 remained alive in CR or PR with a mean survival time of (73.0 +/- 12.5) months. CONCLUSIONS: CCT yields higher response rates, but not longer survival time than MP does for the treatment of MM. The reponse rate as well as the overall survival rate increased when IFNalpha was used as maintenance therapy. Thalidomide can improve response rate as well. HSCT could prolong survival time in patients aged < 60 years with good status.