Clinical Study of Thalidomide Combined with Dexamethasone for the Treatment of Elderly Patients with Newly Diagnosed Multiple Myeloma

Objective: To investigate the relationship between the efficacy and safety of different doses of thalidomide(Thal) plus dexamethasone (Dex) as the initial therapy in elderly patients with newly diagnosed multiplemyeloma (MM). Methods: Clinical data of 28 elderly patients with newly diagnosed MM who underwent theTD regimen as the initial therapy were analyzed retrospectively. The patients were divided into two groupsaccording to the maximal sustained dose of Thal: lower dose (group A) and higher dose (group B). The overallresponse rate (ORR), progression free survival (PFS), overall survival (OS), and adverse events (AES) werecompared between the two groups. Results: A total of 28 patients were followed up with a median of 18 months.The ORR was 60.1%. The median response time and PFS were 2.0 and 17.0 months, respectively. The meansustained dose of Thal in group B was significantly higher than group A (292.9 mg v 180.4 mg, P=0.01). Therewas no significantly difference in ORR (57.1% v 64.3%, P=1.00) and PFS (9.63months v 17.66 months, P=0.73)between groups A and B. During the follow up, only five patients died (<40%) and, therefore, median OS valueswere not available. It is estimated, however, that the mean survival time in the two groups was 35.6 and 33.4months (P>0.05), respectively. All of the patients tolerated the treatment well. The incidence of AES in patientswith a grading above 3 in group B was significantly higher than in group A (P=0.033). Conclusions: The TDregimen results in a high response rate and manageable AES as the initial therapy in elderly patients with MM.TD should be considered as the front line regimen for the treatment of elderly patients with MM in areas withfinancial constraints. The clinical response can be achieved at a low dose Thal with minimal toxicity.     

以阿霉素为主联合化疗治疗恶性肿瘤62例结果分析

本文分析以阿霉素为主联合化疗治疗晚期恶性肿瘤79例,可评价疗效62例,男54例,女8例,中位数年龄58岁(29～72岁),肺癌48例,胃癌9例,肝癌5例,均为检查确诊的晚期肿瘤患者。肺癌48例中 CR+PR 50%(24/48),胃癌9例 CR+PR11%(1/9)。5例肝癌采用肝动脉插管化疗2～4次,3例达 PR,近期疗效较全身化疗明显提高,主要毒性反应:消化道反应,骨髓抑制和脱发。     

Induction Treatment With Cyclophosphamide,Thalidomide, and Dexamethasone in Newly Diagnosed Multiple Myeloma: A Phase II Study

Background:Thalidomide has alternative mechanisms of action; it can be combined with dexamethasone or alkylating agents for the treatment of multiple myeloma (MM); however, the optimal doses and appropriate intervals of thalidomide continue to be debated.Patients and Methods:We assessed the clinical efficacy and toxicity of thalidomide in patients with newly diagnosed MM; 68 patients were treated with pulsed cyclophosphamide, thalidomide, and dexamethasone (CTD) chemotherapy for induction treatment.Results:After a median of 28 months' follow-up, the overall response rate was 79.4%, with a 42.6% complete response (CR) or very good partial response (VGPR). Patients with cytogenetically high-risk disease had poor CR/VGPR rates (27.3%) at a median of 11.5 months of time to progression (TTP) compared with patients with standard-risk disease who achieved CR/VGPR rates (50%) at a median of 20.3 months of TTP. The major adverse events included peripheral sensory neuropathy (14.3%), infection (10.2%), and thromboembolic complications (5.9%). Thirty-two patients who achieved more than a PR proceeded to peripheral blood stem cell collection with a median number of 5.0 × 10⁶ CD34⁺ cells/kg collected.Conclusion:CTD resulted in a favorable response with tolerable toxicity in patients with MM and did not affect the yield of the stem cell collection.     

Modified Bortezomib,Adriamycin and Dexamethasone (PAD) Regimen in Advanced Multiple Myeloma

The PAD regime, composed of bortezomib, adriamycin and dexamethasone, improves the outcomes of patients with advanced multiple myeloma (MM), but at the same time produces high frequency of serious toxic side effects. For the first time, we evaluated the efficacy and safety of a bortezomib-dose-reduced PAD regime in the treatment of relapsed/refractory MM in this clinical study. Forty-five patients were treated with two to six 21-day cycles of PAD, comprising bortezomib at 1.3 mg/m² (P₁AD, n?=?21) or 1.0 mg/m² (P₂AD, n?=?24) (days 1, 4, 8, 11), adriamycin at 9 mg/m² (days 1–4) and dexamethasone at 40 mg/day (days 1–4). Overall, 36 patients (80 %) showed at least partial remission (PR), in which 9 cases (20 %) showed complete remission (CR) and 10 cases (22 %) showed very good partial remission (VGPR). The efficacy of PAD regimen in advanced MM patients was not related to the traditional prognostic factors. There was no significant difference between P₁AD and P₂AD in the rates of PR, CR or VGPR, 1.5-year progression-free survival (PFS), and overall survival (OS) (81 % vs. 79 %, 48 % vs. 38 %, 64 % vs. 59 %, and 85 % vs. 73 %, respectively). However, the grade 3–4 toxic effects, including thrombocytopenia (13 % vs. 38 %), peripheral neuropathy (8 % vs. 33 %) and 3–4 grade gastrointestinal reaction (13 % vs. 43 %), were markedly inhibited after P₂AD compared to P₁AD (P?相似文献   

反应停联合地塞米松治疗多发性骨髓瘤临床疗效分析

目的:探讨应用反应停联合地塞米松治疗多发性骨髓瘤的临床效果及其安全性.方法:2003年1月至2006年1月间我院住院患者40例,随机分为观察组和对照组.对照组单用反应停,观察组加用地塞米松.结果:反应停联合地塞米松组,总有效率85%,显著高于对照组的55%.观察组治疗前后的血常规、血沉、血钙、血清M蛋白等指标的变化更加显著.同时出现轻微的不良反应.结论:反应停联合地塞米松治疗多发性骨髓瘤,有很好的疗效,毒副反应轻微,患者可耐受,值得临床推广应用.     

反应停联合地塞米松治疗多发性骨髓瘤临床疗效分析

目的：探讨应用反应停联合地塞米松治疗多发性骨髓瘤的临床效果及其安全性。方法：2003年1月至2006年1月间我院住院患者40例,随机分为观察组和对照组。对照组单用反应停,观察组加用地塞米松。结果：反应停联合地塞米松组,总有效率85%,显著高于对照组的55%。观察组治疗前后的血常规、血沉、血钙、血清M蛋白等指标的变化更加显著。同时出现轻微的不良反应。结论：反应停联合地塞米松治疗多发性骨髓瘤,有很好的疗效,毒副反应轻微,患者可耐受,值得临床推广应用。     

三氧化二砷、沙利度胺和地塞米松联合治疗复发性、难治性多发性骨髓瘤

[目的]探索治疗复发性、难治性多发性骨髓瘤（MM）的有效方法。[方法]经传统化疗方案和干扰素等治疗后复发、再次治疗困难或无效的MM患者共45例，给予三氧化二砷（As2O3）10mg／d，静脉滴注，第1～28天；地塞米松（DXM）40mg／d，第1～4、9～12、17～20、25～28天：沙利度胺（THL）200mg／d，第1～28天。每4周1个疗程，休息4周，连用2个疗程评价疗效。[结果]95．6％（43／45）患者均有效，其中37．8％（17／45）获PR，57．8％（26／45）获有效。6个月无进展生存率（PFS）和12个月PFS分别为89.3％和73.2％。大部分患者都有不同程度的水钠潴留症状，均未见明显骨髓抑制。[结论]三氧化二砷、沙利度胺和地塞米松联合方案是治疗复发性、难治性MM的有效并安全的方法。     

Combined Thalidomide and Temozolomide Treatment in Patients with Glioblastoma Multiforme

OBJECTIVES: Glioblastoma multiforme (GBM) may potentially be responsive to antiangiogenic therapies as these tumors are highly vascularized and overexpress angiogenic factors. Thalidomide exhibits antiangiogenic activity and may provide additive or synergistic antitumor effects when given concurrently with temozolomide, an alkylating agent. To further evaluate this new concept of combining an antiangiogenic with an alkylating agent, efficacy and tolerability of thalidomide alone and in combination with temozolomide were explored in a single-institution, nonrandomized open-label phase II study. PATIENTS AND METHODS: Forty-four patients with GBMs, who received thalidomide for a period of at least three months, were evaluated for survival, time to tumor progression (TTP), and side effects. Microsurgical tumor extirpation and radiotherapy preceded chemotherapy. Nineteen patients (43%) received thalidomide only (T), and 25 patients (57%) had a combined chemotherapy of thalidomide and temozolomide (TT). Median thalidomide dosage was 200 mg/day. Median temozolomide dosage was 200 mg/m2/day for five days, in monthly cycles. Neuroradiological outcomes were assessed by a semiquantitative grading system. RESULTS: Median survival was 103 weeks (95% CI, 65-141 weeks) for TT-patients and 63 weeks (95% CI, 49-77 weeks) for T-patients (p < 0.01). Median TTP for the TT-group was 36 weeks (95% CI, 20-52 weeks) and 17 weeks (95% CI, 13-21 weeks) for the T-group (p < 0.06). Neuroradiologically, 14 patients (56%) of the TT-group and six (32%) of the T-group had evidence of stable disease on at least two successive neuroradiological follow-ups. Progressive disease was found in nine patients (36%) of the TT-group and in 13 (68%) of the T-group. In two patients (8%) of the TT-group, a response with tumor regression was found. Thalidomide and concurrent temozolomide were safe and well tolerated with mild to moderate toxicities. CONCLUSIONS: The combination of thalidomide and temozolomide in the treatment of GBM appears to be more effective than that of thalidomide alone with respect to survival, TTP, and neuroradiological documentation of progression, stable disease or response. Further concurrent prospective studies of these agents in a larger group of patients with GBM will be required to establish the soundness of these intriguing observations.     

沙立度胺联合地塞米松治疗初发多发性骨髓瘤25例

目的观察沙立度胺联合地塞米松方案治疗多发性骨髓瘤的疗效及其不良反应。方法沙立度胺,口服,起始剂量每天50mg,50mg每晚顿服,根据患者耐受情况每周增加剂量50mg/d,直到最大剂量达到400mg/d。地塞米松40mg/d,第1～4日,第9～12日,第17～20日分别静脉或口服给药,每28日为1个疗程。该方案治疗至少3个月。结果完全缓解4例(16%),部分缓解6例(24%),进展10例(40%),无效5例(20%),总有效率80%。常见的不良反应为便秘、嗜睡、疲乏、水肿、指端麻木等。结论沙立度胺联合地塞米松是初治多发性骨髓瘤有效的治疗方案,不良反应少。     

沙利度胺联合FOLFOX4方案治疗晚期原发性肝癌的疗效分析

目的 探讨沙利度胺联合FOLFOX4方案治疗晚期原发性肝癌的疗效.方法 选择晚期原发性肝癌患者62例为研究对象,随机分为观察组和对照组,观察组患者接受沙度利胺联合FOLFOX4化疗方案,对照组患者接受FOL-FOX4化疗方案,比较2组患者的近期疗效、不良反应发生率及治疗前后AFP的水平.结果 观察组治疗有效率及疾病控制率均明显高于对照组,差异具有统计学意义(P<0.05).2组患者骨髓抑制、消化道反应、神经毒性、嗜睡、乏力、便秘、皮疹等不良反应的发生率差异无统计学意义(P>0.05).治疗后,2组患者血清的AFP水平均明显降低(P<0.05),且观察组患者AFP的水平明显低于对照组治疗后的水平(P<0.05).结论 沙利度胺联合FOLFOX4化疗方案治疗晚期原发性肝癌可明显提高有效率和疾病控制率,降低患者AFP水平,毒副作用可耐受,值得在临床上推广应用.     

劳拉西泮、苯海拉明、氟哌啶醇联合托烷司琼对比地塞米松联合托烷司琼预防高致吐风险化疗呕吐的疗效

目的 探讨劳拉西泮(Ativan)、苯海拉明(Benadryl)和氟哌啶醇(Haldol)的方案(以下简称ABH)联合托烷司琼和地塞米松联合托烷司琼用于高致吐风险化疗[参见2011版多国癌症支持治疗学会(MASCC)止吐指南]后的急性、延迟性呕吐的疗效.方法 104例应用高致吐风险药物单天化疗的患者随机分为ABH组和地塞米松组,两组均在化疗前半小时静脉滴注托烷司琼5 mg,ABH组于化疗头4天予以劳拉西泮0.34 mg、苯海拉明25 mg、氟哌啶醇1.5 mg口服,每天3次;地基米松组于化疗当天予以地塞米松20 mg口服,化疗后3天予以地塞米松8 mg口服,每天2次.使用MASCC止吐问卷及生活功能指数(呕吐)问卷,了解患者急性及延迟性呕心呕吐控制率及生活质量.结果 ABH组和地塞米松组各入组52名患者.两组恶心、呕吐的控制均良好,急性恶心的控制率ABH组和地塞米松组分别为62％和52％,延迟性恶心情况分别为23％和17％,急性呕吐分别为88％和87％;延迟性呕吐分别为77％和65％,ABH的疗效优于地塞米松,但两者差异无统计学意义,可能与样本量小相关.值得一提的是,在延迟性恶心程度控制方面ABH组优于地塞米松组(2.63vs.3.69),两组差异有统计学意义(P＜0.05).两组患者的生活质量均受到中度影响,差异无统计学意义,且均未发生严重不良反应.结论 劳拉西泮、苯海拉明、氟哌啶醇(ABH)联合5HT-3受体拮抗剂预防高致吐风险化疗后的恶心呕吐有一定疗效,可用于化疗相关恶心呕吐的防治.     

醋酸甲地孕酮联合沙利度胺治疗晚期癌症恶液质的效果

目的探究醋酸甲地孕酮联合沙利度胺对晚期癌症恶液质的改善效果。方法选取晚期癌症恶液质患者60例,随机分为对照组(30例)和观察组(30例)。对照组给予一般对症治疗和营养支持并加用醋酸甲地孕酮160mg/次,1次/天。观察组在对照组基础上加用沙利度胺50 mg/次,2次/天,观察周期4周。比较2组治疗前后KPS评分、体质量、进食量、相关生化指标及T细胞亚群的改善情况。结果治疗后,相比于对照组,观察组KPS评分、体质量、进食量、相关生化指标及T细胞亚群水平改善更加明显,差异具有统计学意义(P<0.05)。结论醋酸甲地孕酮联合沙利度胺能显著改善晚期癌症恶液质症状,值得临床推广应用。     

沙利度胺联合GEMOX方案治疗中晚期肝癌的临床观察

目的观察沙利度胺联合吉西他滨及奥沙利铂（GEMOX方案）治疗原发性肝癌的有效性和安全性。方法对15例中晚期肝癌患者行沙利度胺（400 mg/天）,吉西他滨（1 000 mg/m2,第1,8天）及奥沙利铂（130 mg/m2,第1天）方案联合化疗2,1天为1个周期。以RECIST标准评价疗效,以NCI标准评价不良反应。结果 15例患者均可评价客观疗效及不良反应。其总有效率（RR）为40.0%（6/15）,疾病控制率（DCR）为73.3%（11/15）。中位疾病进展时间（TTP）5.5个月。治疗后KPS评分明显改善。结论沙利度胺联合吉西他滨及奥沙利铂治疗原发性肝癌安全有效,耐受性良好。     

新型光敏剂联合阿霉素对乳腺癌细胞增殖及周期的影响

目的:研究新型光敏剂叶绿素衍生物(Chlorophyl derivative4,CPD4),联合阿霉素对人乳腺癌MCF-7细胞增殖及周期的影响,初步探讨联合用药的作用机制,为临床开辟新的治疗方法提供实验依据.方法:以人乳腺癌MCF-7细胞系为研究对象,新型光敏剂和乳腺癌传统化疗药物阿霉素(ADM)联合给药.采用流式细胞仪检测ADM组(2个浓度组分别预处理24小时、48小时)、光动力效应组、联合用药组细胞凋亡率和周期分布:流式细胞仪分析ADM(20ng/mL)预处理24小时、48小时对细胞平均荧光强度的影响以及ADM预处理24小时、48小时后加入CPD4 1.5μg/mL孵育不同时间细胞平均荧光强度的变化.结果:联合用药组细胞凋亡率明显高于单药组,差异有统计学意义(P＜0.01);光动力效应可造成MCF-7细胞G_0/G_1期阻滞,低浓度ADM预处理后GdM期细胞增加,联合用药时G_2/M期细胞升高.ADM预处理MCF-7细胞24小时、48小时细胞平均荧光强度与对照组荧光强度比较差异无统计学意义(P＞0.05);ADM预处理MCF-7后能增加光敏剂CPD4进入细胞的量,在CPD4孵育2小时细胞平均荧光强度最强,且ADM预处理48小时组＞预处理24小时组＞对照组.结论:ADM预处理MCF-7细胞后能够增加光敏剂CPD4进入细胞的量;光动力效应联合ADM具有协同作用.     

硼替佐米联合阿霉素及地塞米松治疗复发难治性套细胞淋巴瘤15例

探讨硼替佐米联合阿霉素、地塞米松组成的PAD（bortezomib、doxorubicin and dexamethasone）方案治疗复发、难治性套细胞淋巴瘤（mantle cell lymphoma,MCL）的疗效及安全性。方法：用PAD方案治疗15例复发、难治性MCL,分析其疗效及影响因素,同时观察不良反应。PAD方案治疗4～6个疗程：硼替佐米（1.3 mg/m2,d1、4、8、11,快速静脉注射）、阿霉素（10 mg/d,d4～6,静脉注射）和地塞米松（40 mg/d,d4～6,口服,每21天为1个疗程）。结果：80%（12/15）患者达PR及PR以上疗效,其中CR 26.7%（4/15,均经PET-CT证实）,PR 53.3%（8/15）。无病进展时间（PFS）13.5（3.5～25.1）个月,中位生存时间（OS）35.6（6.3～42.8）个月。PAD方案主要不良反应表现为：Ⅲ～Ⅳ级血小板减少（33.3%）,Ⅱ级乏力（26.7%）,Ⅱ级周围神经炎（13.3%）,带状疱疹病毒感染（20.0%）。结论：PAD方案可有效提高难治性MCL患者疗效,不良反应多轻微可控。     

沙利度胺联合化疗治疗非霍奇金淋巴瘤临床观察

目的 观察沙利度胺联合化疗治疗非霍奇金淋巴瘤(NHL)的临床疗效及毒副反应.方法 65例NHL分为两组,治疗组36例给予沙利度胺联合化疗,对照组29例仅给予化疗.采用酶联免疫吸附试验检测两组患者治疗前后血清血管内皮细胞生长因子(sVEGF)水平,并观察临床疗效和毒副反应.结果 治疗组总有效率为94.4％,对照组为93....